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Wisconsin rates for HCPCS L5999

Lower extremity prosthesis, not otherwise specified

Insurance Carrier
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,559.00 / $2,559.00 / $2,559.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,161.14 / $1,161.14 / $1,161.14
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9,210.60 / $9,210.60 / $9,210.60
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $58.40 / $85.00
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$65.00 / $65.00 / $1,161.14
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,559.00 / $2,559.00 / $2,559.00