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Wisconsin rates for HCPCS L5617

Addition to lower extremity, quick change self-aligning unit, above knee (AK) or below knee (BK), each

Facilitymedian $692 · 10th–90th $562$1,2590%50%10th90th$692Professionalmedian $490 · 10th–90th $302$1,0230%10%20%10th90th$490$0.5$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
$338.84 / $338.84 / $338.84
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$295.12 / $338.84 / $562.34
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$691.83 / $691.83 / $1,148.15
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$512.86 / $645.65 / $776.25
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$436.52 / $1,584.89 / $3,388.44
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$316.23 / $977.24 / $1,318.26
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$338.84 / $562.34 / $851.14
DeanCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$389.05 / $660.69 / $812.83
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$338.84 / $676.08 / $3,162.28
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$309.03 / $436.52 / $758.58
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$54.95 / $70.79 / $457.09
Network Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,096.48 / $1,096.48 / $1,096.48
Network Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$489.78 / $776.25 / $1,348.96
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$691.83 / $1,023.29 / $1,905.46
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$436.52 / $1,380.38 / $3,162.28
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$316.23 / $630.96 / $3,388.44
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$363.08 / $457.09 / $691.83
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$263.03 / $338.84 / $562.34