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Preparatory Hip/Hemipelvectomy, Thermoplastic Socket

Montana rates for HCPCS L5595

Preparatory, hip disarticulation/hemipelvectomy, pylon, no cover, SACH foot, thermoplastic or equal, molded to patient model

Rates data updated July 2026.

Facilitymedian $4,677 · 10th–90th $3,548$6,6070%20%40%10th90th$4,677Professionalmedian $4,266 · 10th–90th $1,549$9,1200%10%10th90th$4,266$100.0$500.0$2.0K$10.0K

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
Setting
Professional
Modifier
Global
Typical Low
$1,548.82
Median
$4,265.80
Typical High
$28,183.83
Cigna
Setting
Facility
Modifier
Global
Typical Low
$3,548.13
Median
$5,128.61
Typical High
$5,128.61
Cigna
Setting
Professional
Modifier
Global
Typical Low
$3,548.13
Median
$5,128.61
Typical High
$5,128.61
MountainHealth Co-op
Setting
Facility
Modifier
Global
Typical Low
$3,715.35
Median
$4,677.35
Typical High
$9,120.11
MountainHealth Co-op
Setting
Professional
Modifier
Global
Typical Low
$3,715.35
Median
$4,677.35
Typical High
$9,120.11
Providence
Setting
Facility
Modifier
Global
Typical Low
$2,691.53
Median
$4,466.84
Typical High
$6,918.31
Providence
Setting
Professional
Modifier
Global
Typical Low
$79.43
Median
$3,801.89
Typical High
$5,128.61
United
Setting
Facility
Modifier
Global
Typical Low
$3,162.28
Median
$3,630.78
Typical High
$3,801.89
United
Setting
Professional
Modifier
Global
Typical Low
$2,187.76
Median
$2,398.83
Typical High
$3,715.35