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Wisconsin rates for HCPCS L5940

Addition, endoskeletal system, below knee (BK), ultra-light material (titanium, carbon fiber or equal)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$303.70 / $303.70 / $303.70
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$250.80 / $303.70 / $506.09
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$602.04 / $662.26 / $1,095.73
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$559.91 / $559.91 / $740.52
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$433.12 / $1,288.39 / $1,288.39
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$382.03 / $1,244.83 / $2,513.62
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$278.88 / $872.34 / $1,139.43
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$193.91 / $455.57 / $692.36
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$344.72 / $602.04 / $722.46
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$303.70 / $597.36 / $3,201.26
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$279.92 / $402.27 / $679.70
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $70.00 / $344.93
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$193.91 / $455.57 / $692.36
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$344.72 / $602.04 / $722.46
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$602.04 / $926.54 / $1,802.65
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$382.03 / $1,175.88 / $3,201.26
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$278.88 / $382.03 / $3,997.65
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$602.04 / $602.04 / $602.04
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$480.73 / $602.04 / $602.04
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$235.18 / $361.23 / $533.79