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Minnesota rates for HCPCS L5628

Addition to lower extremity, test socket, hemipelvectomy

Facilitymedian $851 · 10th–90th $646–$5,6230%20%10th90th$851Professionalmedian $776 · 10th–90th $339–$8910%50%10th90th$776$0.5$2.0$10.0$50.0$200.0$1.0K$5.0K

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
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$645.65 / $645.65 / $645.65
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$263.03 / $389.05 / $645.65
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$758.58 / $776.25 / $1,000.00
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$616.60 / $776.25 / $776.25
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,698.24 / $2,884.03 / $6,918.31
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$891.25 / $1,023.29 / $1,148.15
Health Partners
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,290.87 / $2,884.03 / $5,623.41
Health Partners
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$891.25 / $891.25 / $1,230.27
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$295.12 / $776.25 / $3,090.30
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$190.55 / $323.59 / $933.25
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$4.57 / $380.19 / $954.99
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$223.87 / $389.05 / $1,071.52