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Wisconsin rates for HCPCS L6690

Upper Extremity Addition Frame Type Socket Interscapular- Thoracic

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$542.36 / $542.36 / $542.36
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$374.27 / $542.36 / $900.52
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,075.13 / $1,182.64 / $1,956.74
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$929.87 / $999.87 / $1,322.40
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$773.45 / $2,300.78 / $2,300.78
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$695.50 / $2,222.32 / $4,487.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$507.72 / $1,558.13 / $2,034.76
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$265.81 / $813.54 / $1,236.40
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$615.61 / $1,002.06 / $1,290.16
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$460.13 / $1,075.13 / $4,434.30
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$436.56 / $620.36 / $1,170.68
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $70.00 / $604.13
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$265.81 / $813.54 / $1,236.40
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$615.61 / $1,002.06 / $1,290.16
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,075.13 / $1,612.70 / $2,470.11
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$695.50 / $2,099.86 / $4,434.30
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$507.72 / $695.50 / $5,447.03
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,075.13 / $1,075.13 / $1,075.13
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,075.13 / $1,075.13 / $1,075.13
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$357.58 / $536.37 / $922.09