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Wisconsin rates for HCPCS L6450

Elbow Disarticulation Molded Socket Endoskeletal System Including Soft Prosthetic Tissue Shaping

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,165.80 / $2,165.80 / $2,165.80
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,549.96 / $2,165.80 / $3,596.05
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,293.29 / $4,722.62 / $7,813.79
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,992.76 / $3,992.76 / $5,280.74
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,088.59 / $9,187.64 / $9,187.64
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,717.61 / $8,876.12 / $17,920.02
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,983.86 / $6,221.72 / $8,125.40
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,191.82 / $3,248.70 / $4,937.28
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,458.25 / $4,293.29 / $5,151.95
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,063.09 / $4,293.29 / $19,464.45
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,933.93 / $2,780.91 / $4,674.85
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $70.00 / $2,267.08
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,191.82 / $3,262.35 / $4,937.28
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,458.25 / $4,293.29 / $5,151.95
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,293.29 / $6,607.24 / $11,076.83
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,717.61 / $8,385.34 / $19,464.45
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,983.86 / $2,717.61 / $24,570.97
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,293.29 / $4,293.29 / $4,293.29
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,293.29 / $4,293.29 / $4,293.29
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,615.97 / $2,575.96 / $4,156.57