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Utah rates for HCPCS L5699

All lower extremity prostheses, shoulder harness

Facilitymedian $158 · 10th–90th $72–$2240%20%40%10th90th$158Professionalmedian $162 · 10th–90th $72–$1,2880%10%10th90th$162$50.0$100.0$200.0$500.0$1.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Small sample — interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$72.44 / $72.44 / $72.44
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$72.44 / $134.90 / $1,288.25
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$169.82 / $169.82 / $169.82
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$123.03 / $123.03 / $169.82
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$60.26 / $162.18 / $213.80
Regence BlueShield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$213.80 / $223.87 / $223.87
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$158.49 / $158.49 / $257.04
Select Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$223.87 / $223.87 / $302.00
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$158.49 / $229.09 / $338.84
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$93.33 / $147.91 / $169.82
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$87.10 / $112.20 / $177.83