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Wisconsin rates for HCPCS L5697

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

Facilitymedian $115 · 10th–90th $93$2090%20%40%10th90th$115Professionalmedian $83 · 10th–90th $48$1740%20%10th90th$83$0.1$0.5$2.0$10.0$50.0$200.0

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
$56.23 / $56.23 / $56.23
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$41.69 / $56.23 / $85.11
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$114.82 / $114.82 / $190.55
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$107.15 / $107.15 / $128.82
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$60.26 / $263.03 / $562.34
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$43.65 / $162.18 / $218.78
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$54.95 / $93.33 / $141.25
DeanCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$102.33 / $147.91 / $186.21
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$56.23 / $112.20 / $512.86
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$47.86 / $69.18 / $128.82
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$44.67 / $58.88 / $85.11
Network Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$181.97 / $181.97 / $181.97
Network Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$81.28 / $128.82 / $223.87
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$114.82 / $173.78 / $302.00
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$60.26 / $229.09 / $616.60
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$43.65 / $87.10 / $660.69
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$63.10 / $72.44 / $114.82
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$39.81 / $56.23 / $93.33