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Wisconsin rates for HCPCS L5979

All Lower Extremity Prosthesis Multi-Axial Ankle Dynamic Response Foot One Piece System

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,518.39 / $1,518.39 / $1,518.39
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,140.84 / $1,518.39 / $2,521.09
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,009.91 / $3,310.90 / $5,478.04
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,799.22 / $2,799.22 / $3,702.18
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,165.32 / $6,441.21 / $6,441.21
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,711.28 / $6,222.29 / $12,563.89
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,249.23 / $4,361.72 / $5,696.50
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$882.05 / $2,277.59 / $3,461.40
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,723.40 / $3,009.91 / $3,617.83
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,518.39 / $3,009.91 / $14,301.99
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,384.64 / $2,011.13 / $3,398.13
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $70.00 / $1,755.90
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$882.05 / $2,277.59 / $3,461.40
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,723.40 / $3,009.91 / $3,617.83
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,009.91 / $4,632.14 / $8,198.21
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,711.28 / $5,878.74 / $14,301.99
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,249.23 / $1,711.28 / $17,908.25
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,009.91 / $3,009.91 / $3,009.91
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,403.33 / $3,009.91 / $3,009.91
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,199.10 / $2,002.14 / $3,009.91