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Wisconsin rates for HCPCS L6647

Upper Extremity Addition Shoulder Lock Mechanism Body Powered Actuator

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$316.22 / $316.22 / $316.22
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$262.54 / $316.22 / $529.78
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$626.85 / $689.54 / $1,140.86
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$564.16 / $582.97 / $771.02
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$450.95 / $1,341.46 / $1,341.46
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$405.51 / $1,384.55 / $2,617.17
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$296.02 / $908.44 / $1,186.35
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$180.36 / $474.33 / $720.88
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$358.93 / $611.79 / $752.22
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$312.20 / $626.85 / $2,919.01
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$286.23 / $418.85 / $682.57
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $70.00 / $423.04
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$180.36 / $474.33 / $720.88
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$358.93 / $611.79 / $752.22
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$626.85 / $964.73 / $1,676.18
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$405.51 / $1,224.32 / $2,919.01
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$296.02 / $405.51 / $3,156.12
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$626.85 / $626.85 / $626.85
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$626.85 / $626.85 / $626.85
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$232.80 / $372.48 / $626.85