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Wisconsin rates for HCPCS L5220

Above Knee Short Prosthesis No Knee Joint (Stubbies) With Articulated Ankle/Foot Dynamically Aligned Each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,936.20 / $1,936.20 / $1,936.20
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,379.09 / $1,936.20 / $3,214.82
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,838.15 / $4,221.97 / $6,985.43
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,454.33 / $3,569.48 / $4,720.92
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,761.16 / $8,213.64 / $8,213.64
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,482.86 / $7,935.24 / $16,020.81
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,812.49 / $5,562.19 / $7,263.99
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,066.25 / $2,904.30 / $4,413.87
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,197.63 / $3,838.15 / $4,605.78
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,845.71 / $3,838.15 / $17,674.86
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,728.91 / $2,487.91 / $4,179.27
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $70.00 / $2,234.15
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,066.25 / $2,904.30 / $4,413.87
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,197.63 / $3,838.15 / $4,605.78
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,838.15 / $5,906.80 / $9,909.53
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,482.86 / $7,496.38 / $17,674.86
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,812.49 / $2,482.86 / $22,536.86
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,838.15 / $3,838.15 / $3,838.15
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,838.15 / $3,838.15 / $3,838.15
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.64 / $2,485.42 / $2,545.08
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,376.34 / $2,202.14 / $3,402.97