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Pennsylvania rates for HCPCS L5628

Addition to lower extremity, test socket, hemipelvectomy

Facilitymedian $676 · 10th–90th $288$1,1220%20%10th90th$676Professionalmedian $339 · 10th–90th $263$6030%20%40%10th90th$339$0.5$5.0$50.0$500.0$5.0K$50.0K

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
$288.40 / $1,122.02 / $1,122.02
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$257.04 / $323.59 / $512.86
Capital Blue Cross
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$5,011.87 / $8,511.38 / $77,624.71
Capital Blue Cross
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$363.08 / $524.81 / $660.69
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$501.19 / $501.19 / $616.60
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$363.08 / $363.08 / $501.19
Emblem Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$562.34 / $794.33 / $1,148.15
Geisinger
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$660.69 / $660.69 / $660.69
Geisinger
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$398.11 / $426.58 / $660.69
Martin's Point
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$288.40 / $288.40 / $288.40
Martin's Point
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$263.03 / $323.59 / $489.78
Oscar Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.60 / $812.83 / $1,174.90
UPMC Health Plan
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$309.03 / $309.03 / $616.60
UPMC Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$309.03 / $575.44 / $741.31
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$263.03 / $794.33 / $912.01
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$288.40 / $363.08 / $616.60