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Wisconsin rates for HCPCS L5634

Addition To Lower Extremity Symes Type Posterior Opening (Canadian) Socket

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$205.06 / $205.06 / $205.06
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$152.09 / $205.06 / $340.47
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$406.49 / $447.14 / $739.81
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$351.57 / $378.04 / $499.98
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$292.42 / $869.89 / $869.89
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$274.64 / $840.52 / $1,696.27
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$200.49 / $589.22 / $769.31
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$117.59 / $307.58 / $467.46
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$232.75 / $406.49 / $487.79
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$203.55 / $406.49 / $1,955.07
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$183.11 / $271.61 / $455.36
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $70.00 / $274.33
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$117.59 / $307.58 / $467.46
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$232.75 / $406.49 / $487.79
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$406.49 / $625.55 / $1,093.03
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$274.64 / $793.92 / $1,955.07
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$200.49 / $274.64 / $2,695.59
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$406.49 / $406.49 / $406.49
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$406.49 / $406.49 / $406.49
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$142.62 / $242.86 / $360.40