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Wisconsin rates for HCPCS L5200

Above Knee Molded Socket Single Axis Constant Friction Knee Shin Sach Foot

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,213.69 / $2,213.69 / $2,213.69
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,828.86 / $2,213.69 / $3,690.48
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,388.25 / $4,827.08 / $7,986.62
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,795.39 / $4,081.07 / $5,397.54
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,156.89 / $9,390.86 / $9,390.86
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,728.17 / $9,072.16 / $18,317.49
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,991.56 / $7,308.49 / $8,305.10
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,277.01 / $3,320.55 / $5,046.49
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,512.59 / $4,388.25 / $5,265.90
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,210.56 / $4,388.25 / $20,802.65
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,978.08 / $2,932.09 / $4,816.75
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $70.00 / $2,675.77
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,277.01 / $3,320.55 / $5,046.49
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,512.59 / $4,388.25 / $5,265.90
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,388.25 / $6,753.34 / $11,868.75
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,728.17 / $8,570.79 / $20,802.65
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,991.56 / $2,728.17 / $24,201.14
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,388.25 / $4,388.25 / $4,388.25
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,388.25 / $4,388.25 / $4,388.25
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,548.82 / $2,637.44 / $3,890.69