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Wisconsin rates for HCPCS L5624

Addition To Lower Extremity Test Socket Above Knee

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$243.13 / $243.13 / $243.13
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$181.77 / $243.13 / $403.69
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$481.97 / $530.16 / $877.19
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$448.23 / $448.23 / $592.82
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$346.72 / $1,031.42 / $1,031.42
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$311.77 / $996.24 / $2,011.17
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$227.60 / $698.44 / $912.16
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$140.54 / $364.70 / $554.27
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$275.97 / $481.97 / $578.36
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$243.13 / $481.97 / $2,310.33
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$217.69 / $322.04 / $524.79
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $70.00 / $294.48
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$140.54 / $364.70 / $554.27
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$275.97 / $481.97 / $578.36
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$481.97 / $741.71 / $1,305.81
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$311.77 / $941.34 / $2,310.33
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$227.60 / $311.77 / $2,879.96
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$481.97 / $481.97 / $481.97
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$481.97 / $481.97 / $481.97
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$181.41 / $290.26 / $427.32