go back

Wisconsin rates for HCPCS L5668

Addition To Lower Extremity Below Knee Molded Distal Cushion

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$69.55 / $69.55 / $69.55
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.46 / $69.55 / $115.47
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$137.86 / $151.65 / $250.91
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$119.23 / $128.21 / $169.56
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$99.18 / $295.02 / $295.02
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$89.19 / $285.18 / $575.22
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.11 / $199.69 / $260.91
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$39.04 / $104.33 / $158.54
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$78.94 / $137.86 / $165.43
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$67.58 / $137.86 / $645.28
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.28 / $91.08 / $151.16
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $61.17 / $85.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$39.04 / $104.33 / $158.54
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$78.94 / $137.86 / $165.43
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$137.86 / $212.19 / $362.34
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$89.19 / $269.26 / $645.28
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.11 / $89.19 / $799.97
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$137.86 / $137.86 / $137.86
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$137.86 / $137.86 / $137.86
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.34 / $80.62 / $118.25