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Wisconsin rates for HCPCS L5696

Addition to lower extremity, above knee (AK) or knee disarticulation, pelvic joint

Facilitymedian $240 · 10th–90th $200$4370%20%40%10th90th$240Professionalmedian $191 · 10th–90th $112$3630%20%10th90th$191$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
$120.23 / $120.23 / $120.23
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$100.00 / $123.03 / $199.53
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$239.88 / $239.88 / $398.11
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$223.87 / $223.87 / $269.15
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$138.04 / $549.54 / $1,174.90
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$102.33 / $338.84 / $457.09
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$120.23 / $194.98 / $295.12
DeanCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$213.80 / $316.23 / $398.11
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$120.23 / $234.42 / $1,174.90
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$109.65 / $158.49 / $275.42
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$54.95 / $70.79 / $151.36
Network Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$380.19 / $380.19 / $380.19
Network Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$169.82 / $269.15 / $467.74
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$239.88 / $363.08 / $691.83
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$138.04 / $478.63 / $1,412.54
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$102.33 / $204.17 / $1,513.56
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$147.91 / $165.96 / $239.88
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$93.33 / $117.49 / $194.98