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Wisconsin rates for HCPCS L5780

Addition Exoskeletal Knee-Shin System Single Axis Pneumatic/Hydra Pneumatic Swing Phase Control

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$808.16 / $808.16 / $808.16
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$572.44 / $808.16 / $1,341.85
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,602.03 / $1,762.23 / $2,915.69
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,489.89 / $1,489.89 / $1,970.49
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,152.50 / $3,428.34 / $3,428.34
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,036.33 / $3,312.38 / $6,687.12
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$756.53 / $2,321.71 / $3,031.96
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$442.58 / $1,212.24 / $1,842.33
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$917.29 / $1,602.03 / $1,922.44
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$766.13 / $1,602.03 / $7,109.86
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$721.64 / $1,032.69 / $1,744.41
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $70.00 / $927.36
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$442.58 / $1,212.24 / $1,842.33
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$917.29 / $1,602.03 / $1,922.44
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,602.03 / $2,465.48 / $4,113.16
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,036.33 / $3,128.96 / $7,109.86
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$756.53 / $1,036.33 / $9,440.37
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,602.03 / $1,602.03 / $1,602.03
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,602.03 / $1,602.03 / $1,602.03
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$596.82 / $1,021.17 / $1,602.03