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Utah rates for HCPCS L5622

Addition to lower extremity, test socket, knee disarticulation

Facilitymedian $275 · 10th–90th $141–$4370%20%40%10th90th$275Professionalmedian $316 · 10th–90th $141–$1,9950%10%20%10th90th$316$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
$141.25 / $141.25 / $141.25
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$141.25 / $263.03 / $1,995.26
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$275.42 / $275.42 / $275.42
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$199.53 / $199.53 / $275.42
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$60.26 / $316.23 / $416.87
Regence BlueShield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$416.87 / $436.52 / $436.52
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$309.03 / $309.03 / $489.78
Select Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$436.52 / $436.52 / $501.19
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$309.03 / $446.68 / $616.60
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$181.97 / $229.09 / $323.59
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$169.82 / $218.78 / $346.74