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Wisconsin rates for HCPCS L5628

Addition to lower extremity, test socket, hemipelvectomy

Facilitymedian $794 · 10th–90th $646$1,4450%50%10th90th$794Professionalmedian $479 · 10th–90th $288$1,1750%10%20%10th90th$479$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
$389.05 / $389.05 / $389.05
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$263.03 / $389.05 / $602.56
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$794.33 / $794.33 / $1,288.25
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$691.83 / $741.31 / $891.25
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$501.19 / $1,819.70 / $3,890.45
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$363.08 / $1,122.02 / $1,479.11
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$380.19 / $630.96 / $977.24
DeanCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$446.68 / $707.95 / $933.25
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$389.05 / $776.25 / $3,090.30
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$288.40 / $436.52 / $831.76
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$54.95 / $70.79 / $389.05
Network Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,258.93 / $1,258.93 / $1,258.93
Network Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$562.34 / $891.25 / $1,548.82
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$794.33 / $1,174.90 / $1,819.70
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$501.19 / $1,584.89 / $3,090.30
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$363.08 / $660.69 / $3,630.78
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$288.40 / $436.52 / $794.33
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$257.04 / $389.05 / $645.65