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Wisconsin rates for HCPCS L5658

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

Facilitymedian $562 · 10th–90th $457$1,0230%50%10th90th$562Professionalmedian $380 · 10th–90th $204$8320%10%20%10th90th$380$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
$275.42 / $275.42 / $275.42
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$190.55 / $275.42 / $407.38
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$562.34 / $562.34 / $912.01
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$524.81 / $524.81 / $630.96
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$363.08 / $1,288.25 / $2,754.23
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$269.15 / $794.33 / $1,047.13
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$269.15 / $446.68 / $691.83
DeanCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$446.68 / $660.69 / $812.83
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$275.42 / $549.54 / $2,344.23
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$239.88 / $331.13 / $616.60
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
$891.25 / $891.25 / $891.25
Network Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$398.11 / $630.96 / $1,096.48
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$562.34 / $831.76 / $1,380.38
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$363.08 / $1,122.02 / $2,344.23
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$269.15 / $537.03 / $2,884.03
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$223.87 / $331.13 / $562.34
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$194.98 / $275.42 / $467.74