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Wisconsin rates for HCPCS L5724

Addition Exoskeletal Knee-Shin System Single Axis Fluid Swing Phase Control

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,052.08 / $1,052.08 / $1,052.08
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$754.69 / $1,052.08 / $1,746.86
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,085.56 / $2,294.12 / $3,795.72
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,939.57 / $1,939.57 / $2,565.23
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,500.34 / $4,463.10 / $4,463.10
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,349.13 / $4,311.43 / $8,705.29
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$984.86 / $3,473.44 / $3,947.09
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$583.49 / $1,578.14 / $2,398.39
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,194.14 / $2,085.56 / $2,502.67
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,010.04 / $2,085.56 / $9,687.79
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$939.44 / $1,361.47 / $2,270.92
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $70.00 / $1,222.60
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$583.49 / $1,578.14 / $2,398.39
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,194.14 / $2,085.56 / $2,502.67
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,085.56 / $3,209.59 / $5,422.99
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,349.13 / $4,073.36 / $9,687.79
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$984.86 / $1,349.13 / $11,956.97
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,085.56 / $2,085.56 / $2,085.56
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,085.56 / $2,085.56 / $2,085.56
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$816.88 / $1,329.37 / $1,849.09