go back

Test Socket, Knee Disarticulation

Montana rates for HCPCS L5622

Addition to lower extremity, test socket, knee disarticulation

Rates data updated July 2026.

Facilitymedian $427 · 10th–90th $316$6170%20%40%10th90th$427Professionalmedian $363 · 10th–90th $141$8320%10%10th90th$363$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. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Professional
Modifier
Global
Typical Low
$141.25
Median
$363.08
Typical High
$1,995.26
BCBS
Setting
Professional
Modifier
Global
Typical Low
$426.58
Median
$426.58
Typical High
$426.58
Cigna
Setting
Facility
Modifier
Global
Typical Low
$275.42
Median
$457.09
Typical High
$457.09
Cigna
Setting
Professional
Modifier
Global
Typical Low
$275.42
Median
$457.09
Typical High
$457.09
MountainHealth Co-op
Setting
Facility
Modifier
Global
Typical Low
$331.13
Median
$426.58
Typical High
$831.76
MountainHealth Co-op
Setting
Professional
Modifier
Global
Typical Low
$331.13
Median
$426.58
Typical High
$831.76
Providence
Setting
Facility
Modifier
Global
Typical Low
$239.88
Median
$436.52
Typical High
$676.08
Providence
Setting
Professional
Modifier
Global
Typical Low
$79.43
Median
$346.74
Typical High
$478.63
United
Setting
Facility
Modifier
Global
Typical Low
$288.40
Median
$323.59
Typical High
$346.74
United
Setting
Professional
Modifier
Global
Typical Low
$194.98
Median
$218.78
Typical High
$331.13