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Wisconsin rates for HCPCS L2500

Addition To Lower Extremity Thigh/Weight Bearing Gluteal/ Ischial Weight Bearing Ring

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$190.20 / $190.20 / $190.20
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$168.78 / $190.20 / $320.55
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$377.04 / $414.74 / $686.21
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$339.33 / $350.65 / $463.75
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$271.24 / $806.87 / $806.87
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$243.89 / $779.54 / $1,573.11
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$178.04 / $627.95 / $713.58
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$114.47 / $285.30 / $433.60
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$215.88 / $377.04 / $473.89
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$190.20 / $377.04 / $1,827.68
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$163.94 / $206.86 / $425.67
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $70.00 / $276.27
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$114.47 / $285.30 / $433.60
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$215.88 / $377.04 / $473.89
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$377.04 / $580.25 / $1,063.92
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$243.89 / $736.40 / $1,827.68
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$178.04 / $243.89 / $2,274.67
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$377.04 / $377.04 / $377.04
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$377.04 / $377.04 / $377.04
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$147.76 / $204.92 / $334.29