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Wisconsin rates for HCPCS L5631

Addition To Lower Extremity Above Knee Or Knee Disarticulation Acrylic Socket

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$266.02 / $266.02 / $266.02
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$219.69 / $266.02 / $443.30
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$527.36 / $580.10 / $959.80
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$474.62 / $490.44 / $648.65
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$379.38 / $1,128.55 / $1,128.55
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$329.53 / $1,090.05 / $2,201.51
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$240.56 / $764.06 / $998.08
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$169.85 / $399.05 / $606.46
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$301.95 / $527.36 / $632.83
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$266.02 / $527.36 / $2,777.21
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$245.20 / $352.37 / $580.10
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $70.00 / $355.89
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$169.85 / $407.03 / $606.46
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$301.95 / $527.36 / $632.83
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$527.36 / $811.59 / $1,578.82
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$329.53 / $1,030.00 / $2,777.21
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$240.56 / $329.53 / $3,480.59
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$527.36 / $527.36 / $527.36
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$527.36 / $527.36 / $527.36
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$210.10 / $347.66 / $467.57