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Wisconsin rates for HCPCS L5726

Addition, exoskeletal knee-shin system, single axis, external joints, fluid swing phase control

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,252.55 / $1,252.55 / $1,252.55
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$869.76 / $1,252.55 / $2,079.69
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,482.94 / $2,731.23 / $4,518.95
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,309.13 / $2,309.13 / $3,054.01
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,786.23 / $5,313.49 / $5,313.49
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,606.19 / $5,133.18 / $10,363.77
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,172.52 / $3,598.13 / $4,699.16
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$672.46 / $1,878.83 / $2,855.38
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,421.68 / $2,367.17 / $2,979.53
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,164.06 / $2,482.94 / $11,048.78
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,118.45 / $1,569.07 / $2,703.62
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $70.00 / $1,675.63
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$672.46 / $1,878.83 / $2,855.38
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,421.68 / $2,367.17 / $2,979.53
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,482.94 / $3,821.20 / $6,250.04
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,606.19 / $4,849.50 / $11,048.78
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,172.52 / $1,606.19 / $13,780.11
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,482.94 / $2,482.94 / $2,482.94
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,482.94 / $2,482.94 / $2,482.94
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$868.03 / $1,321.91 / $2,129.52