go back

Wisconsin rates for HCPCS L5986

All lower extremity prostheses, multiaxial rotation unit (MCP or equal)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$472.35 / $472.35 / $472.35
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$316.83 / $472.35 / $784.28
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$936.35 / $1,029.99 / $1,704.16
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$870.81 / $870.81 / $1,151.71
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$673.60 / $2,003.79 / $2,003.79
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$663.31 / $1,936.18 / $3,908.98
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$484.22 / $1,357.03 / $1,772.11
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$244.96 / $708.53 / $1,076.80
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$536.12 / $936.35 / $1,123.61
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$424.04 / $936.35 / $4,017.59
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$421.78 / $571.58 / $1,019.57
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $70.00 / $560.76
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$244.96 / $708.53 / $1,076.80
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$536.12 / $936.35 / $1,123.61
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$936.35 / $1,441.00 / $2,276.39
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$663.31 / $1,828.80 / $4,017.59
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$484.22 / $663.31 / $5,540.85
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$936.35 / $936.35 / $936.35
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$747.64 / $936.35 / $936.35
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$373.03 / $571.70 / $936.35