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Wisconsin rates for HCPCS L5984

All Endoskeletal Lower Extremity Prostheses Axial Rotation Unit With Or Without Adjustability (Rvsd 1/1/04)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$391.57 / $391.57 / $391.57
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$284.83 / $391.57 / $650.16
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$776.22 / $853.84 / $1,412.72
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$721.88 / $721.88 / $954.75
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$558.41 / $1,661.11 / $1,661.11
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$427.25 / $1,605.05 / $3,239.99
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$311.89 / $1,125.00 / $1,469.06
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$220.22 / $587.36 / $892.65
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$444.45 / $776.22 / $931.46
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$381.21 / $776.22 / $3,613.43
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$349.66 / $513.84 / $852.78
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $70.00 / $594.04
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$220.22 / $587.36 / $892.65
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$444.45 / $776.22 / $931.46
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$776.22 / $1,194.58 / $2,046.54
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$427.25 / $1,516.06 / $3,613.43
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$311.89 / $427.25 / $4,729.14
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$776.22 / $776.22 / $776.22
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$619.79 / $776.22 / $776.22
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$308.30 / $465.73 / $776.22