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Wisconsin rates for HCPCS K0042

Standard Size Footplate Replacement Only Each (Desc Revised 1/1/2017)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$26.03 / $26.03 / $26.03
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.36 / $23.43 / $29.39
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$37.90 / $68.98 / $68.98
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.19 / $35.25 / $51.08
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.15 / $23.66 / $80.98
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$24.94 / $24.94 / $100.93
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.94 / $43.88 / $54.84
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13.94 / $35.10 / $50.45
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.14 / $29.14 / $52.64
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13.94 / $52.64 / $177.61
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.29 / $24.26 / $48.66
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.53 / $50.00 / $65.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13.94 / $35.10 / $50.45
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.14 / $29.14 / $52.64
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.00 / $8.68 / $11.27
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$24.94 / $73.48 / $177.61
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.94 / $24.94 / $29.73
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.86 / $40.86 / $40.86
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.86 / $40.86 / $40.86
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.97 / $23.66 / $46.32