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Utah rates for HCPCS L5975

All lower extremity prostheses, combination single axis ankle and flexible keel foot

Facilitymedian $363 · 10th–90th $162–$5620%20%40%10th90th$363Professionalmedian $407 · 10th–90th $162–$2,3990%10%10th90th$407$50.0$100.0$200.0$500.0$1.0K$2.0K

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
$162.18 / $162.18 / $162.18
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$162.18 / $302.00 / $2,398.83
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$363.08 / $363.08 / $363.08
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$263.03 / $263.03 / $363.08
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$60.26 / $416.87 / $537.03
Regence BlueShield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$537.03 / $562.34 / $562.34
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$389.05 / $407.38 / $616.60
Select Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$549.54 / $562.34 / $575.44
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$407.38 / $575.44 / $676.08
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$208.93 / $331.13 / $371.54
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$194.98 / $251.19 / $416.87