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Wisconsin rates for HCPCS L5975

All Lower Extremity Prosthesis Combination Single Axis Ankle And Flexible Keel Foot

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$282.33 / $282.33 / $282.33
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$234.42 / $282.33 / $473.03
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$559.66 / $615.64 / $1,018.60
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$503.70 / $520.49 / $688.39
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$402.62 / $1,197.69 / $1,197.69
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$362.03 / $1,156.65 / $2,335.87
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$264.27 / $810.94 / $1,059.21
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$161.02 / $423.50 / $643.62
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$320.45 / $546.23 / $671.60
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$278.74 / $559.66 / $2,615.79
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$252.77 / $373.95 / $609.41
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $70.00 / $364.43
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$161.02 / $423.50 / $643.62
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$320.45 / $546.23 / $671.60
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$559.66 / $861.32 / $1,496.52
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$362.03 / $1,093.09 / $2,615.79
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$264.27 / $362.03 / $2,817.63
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$559.66 / $559.66 / $559.66
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$559.66 / $559.66 / $559.66
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$222.96 / $335.80 / $496.21