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South Dakota rates for HCPCS L5628

Addition to lower extremity, test socket, hemipelvectomy

Facilitymedian $646 · 10th–90th $501–$1,0960%50%10th90th$646Professionalmedian $575 · 10th–90th $302–$1,0470%10%10th90th$575$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
$416.87 / $645.65 / $645.65
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$302.00 / $562.34 / $645.65
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$501.19 / $501.19 / $676.08
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$891.25 / $891.25 / $1,122.02
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$512.86 / $645.65 / $1,548.82
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$229.09 / $446.68 / $3,630.78
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$549.54 / $660.69 / $660.69
Midlands
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$676.08 / $676.08 / $676.08
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$549.54 / $549.54 / $1,047.13
Sanford Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$478.63 / $575.44 / $758.58
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$223.87 / $446.68 / $912.01
Wellmark
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$588.84 / $588.84 / $588.84