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Wisconsin rates for HCPCS L5595

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

Facilitymedian $5,623 · 10th–90th $4,677–$10,2330%50%10th90th$5,623Professionalmedian $3,802 · 10th–90th $2,399–$8,5110%20%10th90th$3,802$5.0$20.0$100.0$500.0$2.0K$10.0K$50.0K

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
$2,818.38 / $2,818.38 / $2,818.38
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,187.76 / $2,818.38 / $4,466.84
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$5,623.41 / $5,623.41 / $9,332.54
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$5,128.61 / $5,248.07 / $6,309.57
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$3,548.13 / $12,882.50 / $27,542.29
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,630.27 / $7,943.28 / $10,715.19
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,754.23 / $4,570.88 / $6,918.31
DeanCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3,162.28 / $5,495.41 / $6,760.83
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,818.38 / $5,495.41 / $25,703.96
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,398.83 / $3,467.37 / $6,309.57
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$54.95 / $70.79 / $3,235.94
Network Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$8,912.51 / $8,912.51 / $8,912.51
Network Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3,981.07 / $6,309.57 / $10,964.78
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$5,623.41 / $8,511.38 / $15,135.61
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$3,548.13 / $11,220.18 / $30,902.95
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,630.27 / $5,248.07 / $45,708.82
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$3,162.28 / $3,630.78 / $5,623.41
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,995.26 / $2,754.23 / $4,570.88