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Wisconsin rates for HCPCS L5020

Partial Foot Molded Socket Tibial Tubercle Height With Toe Filler (Special Coverage Instructions Apply. See Mcm: 2323)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,527.83 / $1,527.83 / $1,527.83
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,085.30 / $1,527.83 / $2,536.78
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,028.63 / $3,331.49 / $5,512.11
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,725.76 / $2,816.63 / $3,725.21
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,178.79 / $6,481.27 / $6,481.27
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,486.28 / $6,261.70 / $12,642.26
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,084.98 / $4,388.91 / $5,731.93
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$766.08 / $2,291.75 / $3,482.92
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,734.13 / $3,028.63 / $3,634.36
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,326.11 / $3,028.63 / $12,494.15
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,206.57 / $1,787.92 / $3,297.81
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $70.00 / $1,605.19
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$766.08 / $2,291.75 / $3,482.92
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,734.13 / $3,028.63 / $3,634.36
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,028.63 / $4,542.95 / $7,120.25
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,486.28 / $5,915.30 / $12,494.15
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,084.98 / $1,486.28 / $15,222.86
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,028.63 / $3,028.63 / $3,028.63
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,028.63 / $3,028.63 / $3,028.63
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,428.89 / $1,428.89 / $1,428.89
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,007.30 / $1,785.73 / $3,028.63