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Wisconsin rates for HCPCS L5620

Addition To Lower Extremity Test Socket Below Knee

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$180.53 / $180.53 / $180.53
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$139.01 / $180.53 / $299.75
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$357.88 / $393.67 / $651.34
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$322.08 / $332.83 / $440.19
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$257.45 / $765.86 / $765.86
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$209.59 / $740.15 / $1,493.33
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$153.00 / $518.44 / $677.31
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$107.47 / $270.80 / $411.56
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$204.91 / $351.05 / $429.46
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$180.53 / $357.88 / $1,729.07
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$166.40 / $239.13 / $389.68
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $70.00 / $236.20
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$107.47 / $270.80 / $411.56
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$204.91 / $351.05 / $429.46
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$357.88 / $550.75 / $998.68
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$209.59 / $698.98 / $1,729.07
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$153.00 / $209.59 / $2,202.30
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$357.88 / $357.88 / $357.88
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$285.76 / $357.88 / $357.88
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.27 / $250.52 / $256.52
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.72 / $214.73 / $317.30