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Wisconsin rates for HCPCS L5694

Addition to lower extremity, above knee (AK), pelvic control belt, padded and lined

Facilitymedian $224 · 10th–90th $195$4070%50%10th90th$224Professionalmedian $182 · 10th–90th $102$3310%20%10th90th$182$0.2$1.0$5.0$20.0$100.0$500.0

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
$109.65 / $109.65 / $109.65
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$97.72 / $125.89 / $194.98
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$223.87 / $223.87 / $363.08
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$199.53 / $208.93 / $251.19
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$141.25 / $512.86 / $1,096.48
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$102.33 / $316.23 / $416.87
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$109.65 / $181.97 / $275.42
DeanCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$199.53 / $346.74 / $436.52
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$109.65 / $218.78 / $1,174.90
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$102.33 / $144.54 / $263.03
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$54.95 / $70.79 / $102.33
Network Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$354.81 / $354.81 / $354.81
Network Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$158.49 / $251.19 / $436.52
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$223.87 / $338.84 / $691.83
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$141.25 / $446.68 / $1,380.38
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$102.33 / $204.17 / $1,548.82
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$144.54 / $162.18 / $223.87
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$91.20 / $109.65 / $186.21