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Pelvic Joint, Above-Knee or Knee Disarticulation

Wisconsin rates for HCPCS L5696

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

Rates data updated July 2026.

Facilitymedian $240 · 10th–90th $191$4370%20%40%10th90th$240Professionalmedian $224 · 10th–90th $117$3980%20%10th90th$224$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
Setting
Facility
Modifier
Global
Typical Low
$120.23
Median
$120.23
Typical High
$120.23
Aetna
Setting
Professional
Modifier
Global
Typical Low
$120.23
Median
$120.23
Typical High
$223.87
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$239.88
Median
$239.88
Typical High
$398.11
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$223.87
Median
$223.87
Typical High
$263.03
Cigna
Setting
Facility
Modifier
Global
Typical Low
$138.04
Median
$549.54
Typical High
$1,230.27
Cigna
Setting
Professional
Modifier
Global
Typical Low
$102.33
Median
$346.74
Typical High
$457.09
DeanCare
Setting
Facility
Modifier
Global
Typical Low
$120.23
Median
$194.98
Typical High
$295.12
DeanCare
Setting
Professional
Modifier
Global
Typical Low
$213.80
Median
$316.23
Typical High
$398.11
Medica
Setting
Facility
Modifier
Global
Typical Low
$120.23
Median
$234.42
Typical High
$1,174.90
Medica
Setting
Professional
Modifier
Global
Typical Low
$109.65
Median
$158.49
Typical High
$275.42
Molina
Setting
Professional
Modifier
Global
Typical Low
$54.95
Median
$70.79
Typical High
$151.36
Network Health
Setting
Facility
Modifier
Global
Typical Low
$380.19
Median
$380.19
Typical High
$380.19
Network Health
Setting
Professional
Modifier
Global
Typical Low
$169.82
Median
$269.15
Typical High
$467.74
Prevea360
Setting
Facility
Modifier
Global
Typical Low
$120.23
Median
$194.98
Typical High
$295.12
Prevea360
Setting
Professional
Modifier
Global
Typical Low
$134.90
Median
$234.42
Typical High
$295.12
Quartz
Setting
Professional
Modifier
Global
Typical Low
$239.88
Median
$363.08
Typical High
$660.69
Quartz
Setting
Facility
Modifier
Global
Typical Low
$138.04
Median
$489.78
Typical High
$1,202.26
Quartz
Setting
Professional
Modifier
Global
Typical Low
$102.33
Median
$363.08
Typical High
$1,513.56
United
Setting
Facility
Modifier
Global
Typical Low
$147.91
Median
$165.96
Typical High
$239.88
United
Setting
Professional
Modifier
Global
Typical Low
$93.33
Median
$125.89
Typical High
$229.09