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Wisconsin rates for HCPCS L5677

Additions to lower extremity, below knee (BK), knee joints, polycentric, pair

Facilitymedian $676 · 10th–90th $562–$1,2300%50%10th90th$676Professionalmedian $501 · 10th–90th $295–$1,0230%20%10th90th$501$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
$338.84 / $338.84 / $338.84
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$263.03 / $346.74 / $562.34
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$676.08 / $676.08 / $1,122.02
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$616.60 / $630.96 / $758.58
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$398.11 / $1,548.82 / $3,311.31
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$295.12 / $954.99 / $1,288.25
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$331.13 / $549.54 / $831.76
DeanCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$602.56 / $812.83 / $1,000.00
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$338.84 / $660.69 / $3,162.28
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$295.12 / $426.58 / $758.58
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$54.95 / $70.79 / $398.11
Network Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,071.52 / $1,071.52 / $1,071.52
Network Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$478.63 / $758.58 / $1,318.26
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$676.08 / $1,023.29 / $1,862.09
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$398.11 / $1,348.96 / $3,715.35
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$295.12 / $588.84 / $4,466.84
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$389.05 / $446.68 / $676.08
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$251.19 / $331.13 / $549.54