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Wisconsin rates for HCPCS L5695

Addition to lower extremity, above knee (AK), pelvic control, sleeve suspension, neoprene or equal, each

Facilitymedian $200 · 10th–90th $162$3630%50%10th90th$200Professionalmedian $148 · 10th–90th $93$3020%20%10th90th$148$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
$97.72 / $97.72 / $97.72
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$89.13 / $112.20 / $173.78
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$199.53 / $199.53 / $331.13
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$158.49 / $186.21 / $218.78
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$123.03 / $457.09 / $977.24
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$89.13 / $281.84 / $380.19
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$97.72 / $162.18 / $245.47
DeanCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$177.83 / $295.12 / $371.54
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$97.72 / $194.98 / $1,047.13
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$91.20 / $128.82 / $234.42
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$54.95 / $70.79 / $131.83
Network Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$316.23 / $316.23 / $316.23
Network Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$141.25 / $223.87 / $389.05
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$199.53 / $309.03 / $616.60
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$123.03 / $398.11 / $1,230.27
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$89.13 / $177.83 / $1,288.25
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$117.49 / $147.91 / $199.53
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$81.28 / $97.72 / $165.96