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Wisconsin rates for HCPCS L6692

Upper Extremity Addition Silicone Gel Insert Or Equal Each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$389.49 / $389.49 / $389.49
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$279.61 / $389.49 / $646.69
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$772.09 / $849.30 / $1,405.20
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$694.88 / $718.04 / $949.67
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$555.42 / $1,652.27 / $1,652.27
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$419.41 / $1,596.62 / $3,223.20
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$306.17 / $1,285.89 / $1,461.24
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$216.18 / $584.24 / $887.90
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$442.07 / $772.09 / $926.51
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$374.22 / $772.09 / $3,569.44
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$339.36 / $504.42 / $840.70
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $70.00 / $484.11
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$216.18 / $584.24 / $887.90
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$442.07 / $772.09 / $926.51
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$772.09 / $1,188.20 / $2,009.41
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$419.41 / $1,507.98 / $3,569.44
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$306.17 / $419.41 / $4,296.24
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$772.09 / $772.09 / $772.09
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$616.49 / $772.09 / $772.09
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$302.64 / $463.25 / $662.18