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Wisconsin rates for HCPCS L6641

Upper Extremity Addition Excursion Amplifier Pulley Type

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$119.39 / $119.39 / $119.39
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$80.20 / $119.39 / $198.24
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$236.68 / $260.35 / $430.76
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$213.01 / $220.11 / $291.11
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$170.26 / $506.50 / $506.50
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$126.98 / $489.69 / $988.09
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$92.70 / $394.17 / $447.93
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$62.01 / $179.09 / $272.18
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$135.52 / $236.68 / $284.02
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$107.35 / $236.68 / $1,050.89
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$106.61 / $144.69 / $257.70
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $70.00 / $159.72
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$62.01 / $179.09 / $272.18
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$135.52 / $236.68 / $284.02
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$236.68 / $364.24 / $576.12
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$126.98 / $462.26 / $1,050.89
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$92.70 / $126.98 / $1,232.30
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$236.68 / $236.68 / $236.68
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$236.68 / $236.68 / $236.68
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$120.51 / $120.51 / $120.51
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$80.05 / $142.01 / $209.84