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Utah rates for HCPCS L5628

Addition to lower extremity, test socket, hemipelvectomy

Facilitymedian $389 · 10th–90th $186–$5750%20%40%10th90th$389Professionalmedian $417 · 10th–90th $186–$2,5120%10%10th90th$417$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
$186.21 / $186.21 / $186.21
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$186.21 / $346.74 / $2,511.89
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$501.19 / $501.19 / $501.19
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$363.08 / $363.08 / $501.19
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$60.26 / $426.58 / $549.54
Regence BlueShield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$549.54 / $575.44 / $575.44
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$416.87 / $416.87 / $645.65
Select Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$575.44 / $575.44 / $724.44
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$416.87 / $588.84 / $870.96
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$229.09 / $288.40 / $436.52
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$223.87 / $288.40 / $446.68