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Wisconsin rates for HCPCS L5622

Addition to lower extremity, test socket, knee disarticulation

Facilitymedian $490 · 10th–90th $407$8910%20%40%10th90th$490Professionalmedian $339 · 10th–90th $219$7410%20%10th90th$339$0.5$2.0$10.0$50.0$200.0$1.0K

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
$245.47 / $245.47 / $245.47
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$204.17 / $245.47 / $407.38
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$489.78 / $489.78 / $812.83
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$446.68 / $457.09 / $537.03
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$275.42 / $1,122.02 / $2,398.83
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$199.53 / $691.83 / $933.25
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$239.88 / $398.11 / $602.56
DeanCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$436.52 / $691.83 / $870.96
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$245.47 / $478.63 / $2,344.23
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$218.78 / $309.03 / $549.54
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$54.95 / $70.79 / $295.12
Network Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$776.25 / $776.25 / $776.25
Network Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$346.74 / $549.54 / $954.99
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$489.78 / $741.31 / $1,380.38
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$275.42 / $977.24 / $2,344.23
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$199.53 / $398.11 / $2,884.03
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$229.09 / $323.59 / $489.78
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$181.97 / $239.88 / $398.11