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Wisconsin rates for HCPCS L5976

All Lower Extremity Prostheses Energy Storing Foot (Seattle Carbon Copy Ii Or Equal)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$357.89 / $357.89 / $357.89
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$280.01 / $357.89 / $594.23
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$709.45 / $780.40 / $1,291.20
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$638.50 / $659.79 / $872.62
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$510.38 / $1,518.22 / $1,518.22
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$420.01 / $1,467.15 / $2,961.48
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$306.61 / $1,027.97 / $1,342.69
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$216.49 / $536.84 / $815.87
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$406.21 / $709.45 / $896.23
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$357.89 / $709.45 / $3,565.60
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$329.86 / $474.03 / $800.94
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $70.00 / $478.77
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$216.49 / $547.57 / $815.87
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$406.21 / $709.45 / $896.23
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$709.45 / $1,091.80 / $2,012.42
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$420.01 / $1,385.64 / $3,565.60
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$306.61 / $420.01 / $4,843.43
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$709.45 / $709.45 / $709.45
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$566.47 / $709.45 / $709.45
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$279.45 / $452.22 / $629.00