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Wisconsin rates for HCPCS L5595

Preparatory Hip Disarticulation-Hemipelvectomy Pylon No Cover Sach Foot Thermoplastic Or Equal Molded To Patient Model

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,790.28 / $2,790.28 / $2,790.28
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,123.39 / $2,790.28 / $4,632.92
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,531.20 / $6,084.32 / $10,066.78
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,978.08 / $5,144.02 / $6,803.37
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,979.14 / $11,836.77 / $11,836.77
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,578.08 / $11,435.22 / $23,087.21
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,612.00 / $9,212.04 / $10,468.23
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,556.51 / $4,185.42 / $6,360.88
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,167.03 / $5,531.20 / $6,637.44
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,694.38 / $5,531.20 / $25,854.57
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,443.40 / $3,631.86 / $6,027.54
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $70.00 / $3,261.42
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,556.51 / $4,185.42 / $6,360.88
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,167.03 / $5,531.20 / $6,637.44
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,531.20 / $8,512.32 / $14,466.33
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,578.08 / $10,803.12 / $25,854.57
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,612.00 / $3,578.08 / $45,109.85
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,531.20 / $5,531.20 / $5,531.20
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,531.20 / $5,531.20 / $5,531.20
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,179.12 / $3,628.23 / $5,531.20