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Wisconsin rates for HCPCS L5321

Above Knee Molded Socket Open End Sach Foot Endoskeletal System Single Axis Knee

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,175.67 / $2,175.67 / $2,175.67
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,993.57 / $2,175.67 / $4,022.85
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,312.87 / $4,744.16 / $7,849.42
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,010.97 / $4,010.97 / $5,304.83
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,102.67 / $9,229.54 / $9,229.54
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,481.10 / $9,522.44 / $18,002.59
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,811.20 / $6,249.84 / $8,162.45
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,270.53 / $3,263.52 / $4,959.80
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,469.44 / $4,312.87 / $5,259.79
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,175.67 / $4,312.87 / $20,983.29
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,968.04 / $2,881.74 / $4,869.14
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $70.00 / $2,910.56
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,270.53 / $3,263.52 / $4,959.80
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,469.44 / $4,312.87 / $5,259.79
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,312.87 / $6,637.34 / $11,808.53
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,481.10 / $8,423.58 / $20,983.29
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,811.20 / $2,481.10 / $26,681.22
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,312.87 / $4,312.87 / $4,312.87
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,312.87 / $4,312.87 / $4,312.87
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.14 / $2,961.61 / $3,032.69
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,718.19 / $2,868.86 / $3,698.95