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Wisconsin rates for HCPCS L5617

Addition To Lower Extremity Quick Change Self-Aligning Unit Above Knee Or Below Knee Each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$340.74 / $340.74 / $340.74
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$282.89 / $340.74 / $570.86
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$675.45 / $743.00 / $1,229.32
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$607.90 / $628.16 / $830.80
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$485.91 / $1,445.46 / $1,445.46
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$436.96 / $1,396.80 / $2,818.72
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$318.98 / $978.75 / $1,278.33
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$195.58 / $511.11 / $776.77
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$386.76 / $659.24 / $810.54
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$338.56 / $675.45 / $3,169.20
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$307.02 / $451.33 / $735.48
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $70.00 / $455.84
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$195.58 / $511.11 / $776.77
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$386.76 / $659.24 / $810.54
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$675.45 / $1,039.50 / $1,817.70
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$436.96 / $1,319.24 / $3,169.20
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$318.98 / $436.96 / $3,390.18
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$675.45 / $675.45 / $675.45
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$675.45 / $675.45 / $675.45
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$252.47 / $403.94 / $579.29