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Wisconsin rates for HCPCS L5626

Addition to lower extremity, test socket, hip disarticulation

Facilitymedian $776 · 10th–90th $646$1,4130%20%40%10th90th$776Professionalmedian $468 · 10th–90th $288$1,1220%20%10th90th$468$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
$380.19 / $380.19 / $380.19
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$257.04 / $380.19 / $562.34
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$776.25 / $776.25 / $1,288.25
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$645.65 / $724.44 / $851.14
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$489.78 / $1,778.28 / $3,801.89
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$363.08 / $1,096.48 / $1,479.11
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$380.19 / $630.96 / $954.99
DeanCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$660.69 / $812.83 / $954.99
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$389.05 / $758.58 / $3,090.30
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$288.40 / $426.58 / $870.96
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$54.95 / $70.79 / $309.03
Network Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,230.27 / $1,230.27 / $1,230.27
Network Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$549.54 / $870.96 / $1,513.56
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$776.25 / $1,174.90 / $1,819.70
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$489.78 / $1,548.82 / $3,090.30
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$363.08 / $645.65 / $3,467.37
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$331.13 / $426.58 / $776.25
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$251.19 / $380.19 / $630.96