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Wisconsin rates for HCPCS L5649

Addition To Lower Extremity Ischial Containment/Narrow M-L Socket

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,492.68 / $1,492.68 / $1,492.68
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,192.81 / $1,492.68 / $2,478.41
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,958.96 / $3,254.86 / $5,385.31
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,663.06 / $2,751.83 / $3,639.52
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,128.67 / $6,332.17 / $6,332.17
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,800.00 / $6,117.22 / $12,351.15
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,314.00 / $4,288.13 / $5,600.06
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$736.00 / $2,239.02 / $3,402.80
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,694.22 / $2,300.05 / $3,550.75
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,274.04 / $2,958.96 / $11,959.60
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,178.81 / $1,717.71 / $3,221.94
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $70.00 / $1,597.60
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$736.00 / $2,239.02 / $3,402.80
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,694.22 / $2,300.05 / $3,550.75
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,958.96 / $4,438.43 / $6,840.22
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,800.00 / $5,779.22 / $11,959.60
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,314.00 / $1,800.00 / $14,435.44
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,958.96 / $2,958.96 / $2,958.96
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,958.96 / $2,958.96 / $2,958.96
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,030.40 / $1,520.07 / $2,537.77