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Wisconsin rates for HCPCS L5643

Addition to lower extremity, hip disarticulation, flexible inner socket, external frame

Facilitymedian $2,455 · 10th–90th $2,042$4,4670%20%40%10th90th$2,455Professionalmedian $1,622 · 10th–90th $871$3,6310%20%10th90th$1,622$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
$1,230.27 / $1,230.27 / $1,230.27
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$831.76 / $1,230.27 / $1,819.70
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,454.71 / $2,454.71 / $4,073.80
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,290.87 / $2,290.87 / $2,754.23
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,174.90 / $5,623.41 / $12,022.64
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$851.14 / $3,467.37 / $4,677.35
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,202.26 / $1,995.26 / $3,019.95
DeanCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,380.38 / $2,187.76 / $2,951.21
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,230.27 / $2,398.83 / $9,772.37
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$933.25 / $1,380.38 / $2,630.27
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$54.95 / $70.79 / $1,513.56
Network Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$3,890.45 / $3,890.45 / $3,890.45
Network Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,737.80 / $2,754.23 / $4,786.30
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,454.71 / $3,715.35 / $5,888.44
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,174.90 / $4,897.79 / $10,000.00
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$851.14 / $1,698.24 / $12,302.69
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$933.25 / $1,412.54 / $2,454.71
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$812.83 / $1,202.26 / $1,995.26