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Wisconsin rates for HCPCS L5622

Addition To Lower Extremity Test Socket Knee Disarticulation

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$243.23 / $243.23 / $243.23
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$181.26 / $243.23 / $403.85
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$482.15 / $530.37 / $877.51
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$433.93 / $448.40 / $593.04
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$346.86 / $1,031.80 / $1,031.80
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$274.54 / $997.16 / $2,012.57
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$200.41 / $803.01 / $912.51
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$140.13 / $364.85 / $554.47
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$276.06 / $454.99 / $578.58
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$242.58 / $482.15 / $2,359.33
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$217.18 / $322.14 / $525.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $70.00 / $293.64
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$140.13 / $364.85 / $554.47
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$276.06 / $454.99 / $578.58
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$482.15 / $742.00 / $1,302.80
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$274.54 / $941.70 / $2,359.33
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$200.41 / $274.54 / $2,871.79
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$482.15 / $482.15 / $482.15
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$482.15 / $482.15 / $482.15
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$169.97 / $289.43 / $427.48