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Wisconsin rates for HCPCS L5450

Immediate postsurgical or early fitting, application of nonweight bearing rigid dressing, below knee (BK)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$288.01 / $288.01 / $288.01
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$204.69 / $288.01 / $478.21
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$570.92 / $628.02 / $1,039.08
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$493.79 / $530.96 / $702.24
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$410.72 / $1,221.79 / $1,221.79
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$305.54 / $1,180.10 / $2,383.46
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$223.04 / $827.34 / $1,080.54
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$157.49 / $432.02 / $656.57
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$326.91 / $488.98 / $685.12
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$272.62 / $570.92 / $2,506.23
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$257.18 / $367.48 / $621.66
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $70.00 / $330.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$157.49 / $432.02 / $656.57
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$326.91 / $488.98 / $685.12
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$570.92 / $878.66 / $1,463.39
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$305.54 / $1,115.09 / $2,506.23
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$223.04 / $305.54 / $3,227.30
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$570.92 / $570.92 / $570.92
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$570.92 / $570.92 / $570.92
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$244.40 / $244.40 / $244.40
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$203.29 / $367.11 / $621.66