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Montana rates for HCPCS L5628

Addition to lower extremity, test socket, hemipelvectomy

Facilitymedian $562 · 10th–90th $447–$8130%20%40%10th90th$562Professionalmedian $437 · 10th–90th $186–$7080%10%20%10th90th$437$100.0$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. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$186.21 / $416.87 / $602.56
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$501.19 / $602.56 / $602.56
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$436.52 / $602.56 / $602.56
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$446.68 / $562.34 / $1,096.48
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$446.68 / $562.34 / $1,096.48
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$316.23 / $575.44 / $870.96
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$79.43 / $501.19 / $691.83
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$380.19 / $436.52 / $457.09
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$263.03 / $288.40 / $446.68