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Wisconsin rates for HCPCS L5646

Addition to lower extremity, below knee (BK), air, fluid, gel or equal, cushion socket

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$375.97 / $375.97 / $375.97
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$273.95 / $375.97 / $624.25
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$745.29 / $819.82 / $1,356.43
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$670.76 / $693.12 / $916.70
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$536.16 / $1,594.92 / $1,594.92
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$410.92 / $1,540.33 / $3,111.23
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$299.97 / $1,080.00 / $1,410.51
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$211.80 / $563.96 / $857.08
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$426.73 / $657.62 / $894.35
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$366.64 / $745.29 / $3,432.45
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$332.49 / $494.21 / $811.53
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $70.00 / $443.80
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$211.80 / $563.96 / $857.08
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$426.73 / $657.62 / $894.35
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$745.29 / $1,146.96 / $1,968.26
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$410.92 / $1,455.64 / $3,432.45
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$299.97 / $410.92 / $4,241.91
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$745.29 / $745.29 / $745.29
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$745.29 / $745.29 / $745.29
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$296.52 / $447.17 / $745.29