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Wisconsin rates for HCPCS L5962

Addition Endoskeletal System Below Knee Flexible Protective Outer Surface Covering System

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$355.90 / $355.90 / $355.90
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$317.22 / $355.90 / $640.12
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$705.49 / $776.04 / $1,283.99
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$656.11 / $656.11 / $867.75
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$507.52 / $1,509.75 / $1,509.75
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$448.56 / $1,458.70 / $2,944.68
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$327.45 / $1,022.34 / $1,335.19
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$227.22 / $533.85 / $811.31
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$403.95 / $705.49 / $940.65
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$355.90 / $703.33 / $3,726.17
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$328.02 / $471.39 / $796.49
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $70.00 / $411.56
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$227.22 / $533.85 / $811.31
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$403.95 / $705.49 / $940.65
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$705.49 / $1,085.73 / $2,111.78
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$448.56 / $1,377.90 / $3,726.17
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$327.45 / $448.56 / $4,656.22
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$705.49 / $705.49 / $705.49
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$563.32 / $705.49 / $705.49
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$470.15 / $470.15 / $470.15
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$281.06 / $469.28 / $705.49