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Utah rates for HCPCS L5642

Addition to lower extremity, above knee (AK), leather socket

Facilitymedian $490 · 10th–90th $240–$1,0000%20%40%10th90th$490Professionalmedian $692 · 10th–90th $240–$3,2360%10%10th90th$692$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
$239.88 / $239.88 / $239.88
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$239.88 / $489.78 / $3,235.94
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$524.81 / $524.81 / $524.81
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$389.05 / $389.05 / $549.54
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$60.26 / $724.44 / $933.25
Regence BlueShield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$933.25 / $1,000.00 / $1,000.00
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$707.95 / $707.95 / $1,122.02
Select Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$851.14 / $1,000.00 / $1,000.00
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$707.95 / $1,000.00 / $1,202.26
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$275.42 / $371.54 / $562.34
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$288.40 / $371.54 / $575.44