go back

Wisconsin rates for HCPCS L5696

Addition To Lower Extremity Above Knee Or Knee Disarticulation Pelvic Joint

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$119.28 / $119.28 / $119.28
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$92.51 / $119.28 / $198.04
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$236.44 / $260.08 / $430.32
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$212.79 / $219.89 / $290.82
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$170.09 / $505.98 / $505.98
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$138.76 / $488.74 / $986.69
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$101.29 / $342.66 / $447.49
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$71.52 / $178.92 / $271.91
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$135.38 / $236.44 / $296.08
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$119.28 / $236.44 / $1,184.51
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$109.94 / $158.00 / $266.95
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $70.00 / $149.86
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$71.52 / $182.50 / $271.91
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$135.38 / $236.44 / $296.08
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$236.44 / $363.89 / $664.45
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$138.76 / $461.80 / $1,184.51
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$101.29 / $138.76 / $1,469.79
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$236.44 / $236.44 / $236.44
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$236.44 / $236.44 / $236.44
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$355.31 / $355.31 / $355.31
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$94.20 / $147.72 / $209.63