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Wisconsin rates for HCPCS L5702

Replacement Socket Hip Disarticulation Including Hip Joint Molded To Patient Model

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,920.74 / $2,920.74 / $2,920.74
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,176.55 / $2,920.74 / $4,849.53
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,789.81 / $6,368.79 / $10,537.45
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,210.82 / $5,384.52 / $7,121.46
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,165.18 / $12,390.19 / $12,390.19
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,745.37 / $11,969.91 / $24,167.67
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,734.12 / $9,642.74 / $10,957.66
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,679.50 / $4,381.10 / $6,658.28
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,315.11 / $5,789.81 / $6,952.84
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,907.28 / $5,789.81 / $27,462.75
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,636.46 / $3,868.60 / $6,503.81
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $70.00 / $3,907.29
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,679.50 / $4,381.10 / $6,658.28
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,315.11 / $5,789.81 / $6,952.84
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,789.81 / $8,910.33 / $15,609.54
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,745.37 / $11,308.22 / $27,462.75
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,734.12 / $3,745.37 / $34,404.35
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,789.81 / $5,789.81 / $5,789.81
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,789.81 / $5,789.81 / $5,789.81
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,167.94 / $3,468.70 / $5,133.34