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Wisconsin rates for HCPCS L5250

Hip Disarticulation Canadian Type; Molded Socket Hip Joint Single Axis Constant Friction Knee Shin Sach Foot

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,405.02 / $3,405.02 / $3,405.02
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,594.21 / $3,405.02 / $5,653.62
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,749.81 / $7,424.79 / $12,284.65
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,074.82 / $6,277.32 / $8,302.26
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,855.80 / $14,444.59 / $14,444.59
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,366.38 / $13,954.89 / $28,174.62
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,187.46 / $9,781.41 / $12,774.54
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,005.72 / $5,107.53 / $7,762.28
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,864.78 / $6,749.81 / $8,303.35
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,405.02 / $6,749.81 / $33,390.44
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,138.35 / $4,510.04 / $7,620.43
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $70.00 / $4,202.66
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,005.72 / $5,107.53 / $7,762.28
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,864.78 / $6,749.81 / $8,303.35
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,749.81 / $10,387.75 / $18,641.72
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,366.38 / $13,183.22 / $33,390.44
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,187.46 / $4,366.38 / $45,658.26
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,749.81 / $6,749.81 / $6,749.81
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,749.81 / $6,749.81 / $6,749.81
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,689.04 / $4,489.88 / $6,749.81