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Missouri rates for HCPCS L5628

Addition to lower extremity, test socket, hemipelvectomy

Facilitymedian $501 · 10th–90th $288–$1,3490%20%10th90th$501Professionalmedian $363 · 10th–90th $263–$6170%20%10th90th$363$0.5$2.0$10.0$50.0$200.0$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. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$275.42 / $407.38 / $407.38
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$257.04 / $380.19 / $645.65
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$616.60 / $616.60 / $2,187.76
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$346.74 / $354.81 / $575.44
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$371.54 / $371.54 / $616.60
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$501.19 / $501.19 / $524.81
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$363.08 / $363.08 / $501.19
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$316.23 / $489.78 / $1,584.89
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$223.87 / $323.59 / $3,630.78
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$380.19 / $501.19 / $501.19
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$229.09 / $302.00 / $457.09