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Utah rates for HCPCS L5658

Addition to lower extremity, socket insert, above knee (AK) (Kemblo, Pelite, Aliplast, Plastazote or equal)

Facilitymedian $288 · 10th–90th $141–$5010%20%40%10th90th$288Professionalmedian $363 · 10th–90th $141–$1,9500%10%10th90th$363$50.0$100.0$200.0$500.0$1.0K

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 / $1,949.84
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
$269.15 / $269.15 / $363.08
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$60.26 / $363.08 / $478.63
Regence BlueShield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$478.63 / $501.19 / $501.19
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$354.81 / $354.81 / $562.34
Select Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$457.09 / $501.19 / $575.44
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$354.81 / $512.86 / $707.95
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$165.96 / $223.87 / $331.13
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$169.82 / $218.78 / $346.74