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Wisconsin rates for HCPCS L5988

Addition To Lower Limb Prosthesis Vertical Shock Reducing Pylon Feature

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,216.58 / $1,216.58 / $1,216.58
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,010.07 / $1,216.58 / $2,038.23
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,411.64 / $2,652.80 / $4,389.18
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,085.83 / $2,242.83 / $2,966.31
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,734.93 / $5,160.91 / $5,160.91
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,346.19 / $4,985.89 / $10,067.06
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$982.72 / $3,495.00 / $4,564.22
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$693.87 / $1,824.87 / $2,773.39
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,380.85 / $2,353.86 / $2,893.97
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,201.11 / $2,411.64 / $11,271.87
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,089.24 / $1,611.39 / $2,625.98
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $70.00 / $1,570.37
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$693.87 / $1,824.87 / $2,773.39
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,380.85 / $2,353.86 / $2,893.97
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,411.64 / $3,711.45 / $6,448.77
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,346.19 / $4,710.24 / $11,271.87
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$982.72 / $1,346.19 / $12,141.34
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,411.64 / $2,411.64 / $2,411.64
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,925.63 / $2,411.64 / $2,411.64
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$841.56 / $1,433.07 / $2,411.64