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Washington rates for HCPCS L5628

Addition to lower extremity, test socket, hemipelvectomy

Facilitymedian $708 · 10th–90th $457$1,5490%20%10th90th$708Professionalmedian $468 · 10th–90th $275$9550%10%10th90th$468$1.0$5.0$20.0$100.0$500.0$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. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$467.74 / $467.74 / $1,122.02
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$263.03 / $346.74 / $645.65
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$630.96 / $707.95 / $707.95
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$630.96 / $630.96 / $812.83
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
Kaiser Permanente
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$363.08 / $851.14 / $2,041.74
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$363.08 / $812.83 / $1,348.96
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$75.86 / $562.34 / $616.60
Pacific Source
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$575.44 / $645.65 / $724.44
Pacific Source
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$575.44 / $575.44 / $794.33
Premera BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$630.96 / $1,071.52 / $1,445.44
Premera BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$602.56 / $602.56 / $707.95
Regence BlueShield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$707.95 / $707.95 / $707.95
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$616.60 / $630.96 / $812.83
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$380.19 / $794.33 / $954.99
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$269.15 / $389.05 / $549.54
Wellpoint
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$181.97 / $630.96 / $1,122.02