HCPCS L5628
Addition to lower extremity, test socket, hemipelvectomy
Current code24 hospitals with prices
What Washington hospitals publish for this code
Medicare Advantage: Rate for a private Medicare Advantage plan. Applies only to members of that plan.
| Hospital | Medicare Advantage rates (lowest – highest) | Cash price | List price (before discounts) |
|---|---|---|---|
| Capital Medical Center | $725 – $798 | — | — |
| Deaconess Medical Center | $725 – $798 | — | — |
| Harborview Medical Center | $740 – $814 | $907 | $1,295 |
| Kadlec Regional Medical Center | $740 – $888 | — | — |
| Mary Bridge Children's Hospital | $725 – $798 | — | — |
| MultiCare Auburn Medical Center | $725 – $798 | — | — |
| MultiCare Covington Medical Center | $725 – $798 | — | — |
| MultiCare Good Samaritan Hospital | $725 – $798 | — | — |
| MultiCare Valley Hospital | $747 – $798 | — | — |
| Overlake Hospital Medical Center & Clinics | $740 – $770 | — | — |
| Prov Sacred HRT Med Ctr & Childs Hosp. | $740 – $888 | — | — |
| Providence Centralia Hospital | $740 – $1,184 | — | — |
| Providence Regional Medical Center Everett | $740 – $814 | — | — |
| Providence St Peter Hospital | $740 – $1,184 | — | — |
| Seattle Children's Hospital | — | $2,080 | $2,080 |
| Swedish Edmonds Hospital | $740 – $888 | — | — |
| Swedish Issaquah | $740 – $888 | — | — |
| Swedish Medical Center | $740 – $888 | — | — |
| Swedish Medical Center / Cherry Hill | $740 – $888 | — | — |
| Tacoma General Allenmore Hospital | $725 – $798 | — | — |
| University of Washington Medical Ctr | $740 – $814 | $1,145 | $1,636 |
| Virginia Mason Medical Center | $508 – $762 | — | — |
| Wellfound Behavioral Health Hospital | — | — | — |
| Yakima Valley Memorial | $725 – $812 | — | — |
Medicare (traditional) reference
Only for people on original Medicare. These are CMS’s 2026 amounts. They aren’t what private insurance or cash patients pay.
- Equipment fee, Washington
- $740 (fee)