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Wisconsin rates for HCPCS L6625

Upper Extremity Addition Rotation Wrist Unit With Cable Lock

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$322.02 / $322.02 / $322.02
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$303.83 / $322.02 / $613.11
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$638.35 / $702.19 / $1,161.80
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$574.51 / $593.66 / $785.17
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$459.24 / $1,366.07 / $1,366.07
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$412.94 / $1,319.89 / $2,664.77
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$301.45 / $924.84 / $1,208.13
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$205.60 / $483.03 / $734.10
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$365.50 / $638.35 / $851.13
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$322.02 / $638.35 / $3,399.27
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$296.80 / $426.53 / $720.69
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $65.00 / $85.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$205.60 / $492.69 / $734.10
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$365.50 / $638.35 / $851.13
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$638.35 / $982.39 / $1,911.04
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$412.94 / $1,246.78 / $3,399.27
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$301.45 / $412.94 / $4,786.20
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$638.35 / $638.35 / $638.35
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$638.35 / $638.35 / $638.35
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$265.39 / $424.62 / $547.48