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Wisconsin rates for HCPCS L5655

Addition to lower extremity, socket insert, below knee (BK) (Kemblo, Pelite, Aliplast, Plastazote or equal)

Facilitymedian $347 · 10th–90th $288$6310%50%10th90th$347Professionalmedian $257 · 10th–90th $162$5250%20%10th90th$257$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
$173.78 / $173.78 / $173.78
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$151.36 / $173.78 / $295.12
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$346.74 / $346.74 / $575.44
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$295.12 / $323.59 / $389.05
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$218.78 / $794.33 / $1,698.24
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$162.18 / $489.78 / $660.69
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$173.78 / $281.84 / $426.58
DeanCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$309.03 / $478.63 / $616.60
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$173.78 / $338.84 / $1,737.80
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$158.49 / $229.09 / $398.11
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$54.95 / $70.79 / $229.09
Network Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$549.54 / $549.54 / $549.54
Network Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$245.47 / $389.05 / $676.08
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$346.74 / $524.81 / $1,000.00
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$218.78 / $691.83 / $1,995.26
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$162.18 / $323.59 / $2,041.74
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$190.55 / $239.88 / $346.74
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$131.83 / $169.82 / $295.12