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Wisconsin rates for HCPCS L5685

Addition to lower extremity prosthesis, below knee, suspension/sealing sleeve, with or without valve, any material, each

Facilitymedian $158 · 10th–90th $141$2880%50%10th90th$158Professionalmedian $115 · 10th–90th $68$2340%20%10th90th$115$0.1$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
$77.62 / $77.62 / $77.62
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$67.61 / $77.62 / $134.90
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$158.49 / $158.49 / $263.03
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$147.91 / $147.91 / $177.83
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$100.00 / $363.08 / $776.25
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$72.44 / $223.87 / $302.00
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$77.62 / $128.82 / $194.98
DeanCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$141.25 / $213.80 / $269.15
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$77.62 / $154.88 / $724.44
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$70.79 / $100.00 / $173.78
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$51.29 / $70.79 / $85.11
Network Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$251.19 / $251.19 / $251.19
Network Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$112.20 / $177.83 / $309.03
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$158.49 / $234.42 / $436.52
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$100.00 / $316.23 / $724.44
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$72.44 / $144.54 / $776.25
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$81.28 / $104.71 / $158.49
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$60.26 / $77.62 / $128.82