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Wisconsin rates for HCPCS L5665

Addition To Lower Extremity Socket Insert Multi-Durometer Below Knee

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$352.61 / $352.61 / $352.61
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$256.01 / $352.61 / $585.47
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$698.99 / $768.89 / $1,272.16
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$629.09 / $650.05 / $859.75
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$502.86 / $1,495.84 / $1,495.84
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$452.18 / $1,444.65 / $2,918.09
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$330.09 / $1,012.97 / $1,322.90
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$197.93 / $528.91 / $803.84
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$400.23 / $698.99 / $838.79
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$342.62 / $698.99 / $3,241.88
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$314.86 / $461.84 / $766.49
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $70.00 / $414.74
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$197.93 / $539.49 / $803.84
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$400.23 / $698.99 / $838.79
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$698.99 / $1,075.73 / $1,839.78
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$452.18 / $1,365.22 / $3,241.88
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$330.09 / $452.18 / $4,227.08
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$698.99 / $698.99 / $698.99
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$698.99 / $698.99 / $698.99
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$983.28 / $983.28 / $983.28
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$240.06 / $419.39 / $619.74