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Wisconsin rates for HCPCS L5570

Preparatory, above knee (AK), knee disarticulation, ischial level socket, nonalignable system, pylon, no cover, SACH foot, thermoplastic or equal, direct formed

Facilitymedian $2,818 · 10th–90th $2,291$5,1290%50%10th90th$2,818Professionalmedian $1,995 · 10th–90th $1,230$4,1690%20%10th90th$1,995$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
$1,380.38 / $1,380.38 / $1,380.38
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,096.48 / $1,380.38 / $2,290.87
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,818.38 / $2,818.38 / $4,570.88
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,570.40 / $2,570.40 / $3,090.30
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,778.28 / $6,456.54 / $13,803.84
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,288.25 / $3,981.07 / $5,248.07
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,348.96 / $2,238.72 / $3,467.37
DeanCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,548.82 / $2,754.23 / $3,311.31
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,380.38 / $2,754.23 / $12,882.50
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,230.27 / $1,737.80 / $3,090.30
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$54.95 / $70.79 / $1,621.81
Network Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$4,365.16 / $4,365.16 / $4,365.16
Network Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,995.26 / $3,162.28 / $5,495.41
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,818.38 / $4,168.69 / $7,585.78
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,778.28 / $5,495.41 / $14,791.08
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,288.25 / $2,570.40 / $15,488.17
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,445.44 / $1,819.70 / $2,818.38
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,096.48 / $1,412.54 / $2,344.23