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Wisconsin rates for HCPCS L5661

Addition to lower extremity, socket insert, multidurometer Symes

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$396.63 / $396.63 / $396.63
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$304.27 / $396.63 / $658.55
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$786.24 / $864.86 / $1,430.96
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$731.20 / $731.20 / $967.07
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$565.60 / $1,682.55 / $1,682.55
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$456.40 / $1,625.69 / $3,281.98
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$333.17 / $1,139.53 / $1,488.01
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$235.24 / $594.95 / $904.18
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$450.17 / $786.24 / $943.49
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$396.63 / $786.24 / $3,730.43
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$365.56 / $525.33 / $887.63
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $70.00 / $492.91
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$235.24 / $606.84 / $904.18
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$450.17 / $786.24 / $943.49
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$786.24 / $1,209.97 / $2,186.06
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$456.40 / $1,535.62 / $3,730.43
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$333.17 / $456.40 / $4,333.49
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$786.24 / $786.24 / $786.24
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$786.24 / $786.24 / $786.24
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$360.00 / $360.00 / $360.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$303.66 / $485.86 / $786.24