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Wisconsin rates for HCPCS L5975

All lower extremity prostheses, combination single axis ankle and flexible keel foot

Facilitymedian $575 · 10th–90th $468–$1,0470%20%40%10th90th$575Professionalmedian $417 · 10th–90th $245–$8510%20%10th90th$417$0.5$2.0$10.0$50.0$200.0$1.0K

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
$281.84 / $281.84 / $281.84
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$239.88 / $281.84 / $467.74
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$575.44 / $575.44 / $933.25
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$537.03 / $537.03 / $645.65
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$363.08 / $1,318.26 / $2,818.38
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$263.03 / $812.83 / $1,071.52
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$281.84 / $457.09 / $707.95
DeanCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$512.86 / $741.31 / $933.25
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$281.84 / $562.34 / $2,630.27
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$251.19 / $354.81 / $630.96
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$54.95 / $70.79 / $363.08
Network Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$912.01 / $912.01 / $912.01
Network Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$407.38 / $645.65 / $1,122.02
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$575.44 / $851.14 / $1,584.89
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$363.08 / $1,148.15 / $2,630.27
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$263.03 / $524.81 / $2,818.38
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$295.12 / $371.54 / $575.44
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$218.78 / $281.84 / $467.74