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Wisconsin rates for HCPCS L5505

Initial Above Knee - Knee Disarticulation Ischial Level Socket Non-Alignable System Pylon No Cover Sach Foot Plaster Socket Direct Formed

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,263.32 / $1,263.32 / $1,263.32
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$888.12 / $1,263.32 / $2,097.59
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,504.29 / $2,754.72 / $4,557.81
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,165.96 / $2,328.98 / $3,080.27
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,801.59 / $5,359.18 / $5,359.18
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,620.00 / $5,177.28 / $10,453.34
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,182.59 / $3,629.06 / $4,739.58
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$672.36 / $1,894.98 / $2,879.93
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,433.90 / $2,504.29 / $3,005.15
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,163.89 / $2,504.29 / $11,250.63
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,128.07 / $1,568.85 / $2,726.87
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $70.00 / $1,407.82
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$672.36 / $1,894.98 / $2,879.93
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,433.90 / $2,504.29 / $3,005.15
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,504.29 / $3,854.04 / $6,249.04
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,620.00 / $4,891.20 / $11,250.63
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,182.59 / $1,620.00 / $13,778.13
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,504.29 / $2,504.29 / $2,504.29
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,504.29 / $2,504.29 / $2,504.29
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,340.15 / $3,340.15 / $3,340.15
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$832.91 / $1,388.64 / $2,147.83