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Texas rates for HCPCS L5628

Addition to lower extremity, test socket, hemipelvectomy

Facilitymedian $525 · 10th–90th $302$1,3180%10%10th90th$525Professionalmedian $339 · 10th–90th $263$6030%20%10th90th$339$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
$302.00 / $302.00 / $323.59
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$263.03 / $338.84 / $602.56
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$407.38 / $407.38 / $407.38
Christus
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$79.43 / $707.95 / $707.95
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$501.19 / $501.19 / $501.19
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$363.08 / $363.08 / $501.19
Lucent Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$3,162.28 / $3,162.28 / $3,162.28
Lucent Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3,630.78 / $4,466.84 / $4,466.84
Moda Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$275.42 / $537.03 / $870.96
Moda Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$275.42 / $346.74 / $707.95
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$407.38 / $407.38 / $416.87
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$288.40 / $512.86 / $870.96
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$363.08 / $363.08 / $501.19
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$263.03 / $446.68 / $676.08
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$239.88 / $354.81 / $446.68
Wellpoint
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$346.74 / $707.95 / $707.95