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Wisconsin rates for HCPCS L5679

Addition to lower extremity, below knee (BK)/above knee (AK), custom fabricated from existing mold or prefabricated, socket insert, silicone gel, elastomeric, or equal, with or without perforations, with or without breathable material, not for use with locking mechanism

Facilitymedian $813 · 10th–90th $724–$1,4790%50%10th90th$813Professionalmedian $550 · 10th–90th $339–$1,2020%10%20%10th90th$550$1.0$5.0$20.0$100.0$500.0$2.0K

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
$398.11 / $398.11 / $398.11
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$316.23 / $398.11 / $645.65
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$812.83 / $812.83 / $1,318.26
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$758.58 / $758.58 / $912.01
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$436.52 / $1,862.09 / $3,981.07
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$323.59 / $1,148.15 / $1,513.56
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$389.05 / $645.65 / $1,000.00
DeanCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$724.44 / $954.99 / $1,174.90
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$398.11 / $794.33 / $3,467.37
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$346.74 / $478.63 / $851.14
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$54.95 / $70.79 / $537.03
Network Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,288.25 / $1,288.25 / $1,288.25
Network Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$575.44 / $912.01 / $1,584.89
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$812.83 / $1,202.26 / $2,089.30
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$436.52 / $1,621.81 / $3,715.35
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$323.59 / $645.65 / $3,801.89
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$398.11 / $501.19 / $812.83
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$295.12 / $398.11 / $660.69