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Wisconsin rates for HCPCS L5728

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,467.85 / $1,467.85 / $1,467.85
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,189.72 / $1,467.85 / $2,437.19
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,909.74 / $3,200.71 / $5,295.73
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,516.63 / $2,706.06 / $3,578.98
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,093.26 / $6,226.84 / $6,226.84
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,050.41 / $6,015.90 / $12,145.42
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,496.80 / $4,846.07 / $5,506.90
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$919.83 / $2,201.78 / $3,346.20
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,666.04 / $2,909.74 / $3,807.96
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,467.85 / $2,909.74 / $15,093.28
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,352.89 / $1,944.20 / $3,285.04
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $70.00 / $1,927.36
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$919.83 / $2,245.81 / $3,346.20
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,666.04 / $2,909.74 / $3,807.96
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,909.74 / $4,477.99 / $8,549.52
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,050.41 / $5,683.08 / $15,093.28
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,496.80 / $2,050.41 / $18,918.90
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,909.74 / $2,909.74 / $2,909.74
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,909.74 / $2,909.74 / $2,909.74
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,159.20 / $1,899.75 / $2,579.82