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Wisconsin rates for HCPCS L5653

Addition To Lower Extremity Knee Disarticulation Expandable Wall Socket

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$411.88 / $411.88 / $411.88
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$290.99 / $411.88 / $683.87
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$816.48 / $898.13 / $1,485.99
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$759.33 / $759.33 / $1,004.27
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$587.37 / $1,747.27 / $1,747.27
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$555.76 / $1,687.60 / $3,407.94
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$405.70 / $1,183.13 / $1,545.25
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$224.98 / $617.82 / $938.95
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$467.47 / $781.94 / $979.78
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$389.45 / $816.48 / $3,703.71
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$367.77 / $524.95 / $889.04
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $70.00 / $525.13
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$224.98 / $617.82 / $938.95
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$467.47 / $781.94 / $979.78
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$816.48 / $1,256.51 / $2,090.71
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$555.76 / $1,594.68 / $3,703.71
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$405.70 / $555.76 / $4,638.32
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$816.48 / $816.48 / $816.48
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$816.48 / $816.48 / $816.48
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$290.41 / $464.66 / $700.24