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Wisconsin rates for HCPCS L5785

Addition Exoskeletal System Below Knee Ultra-Light Material (Titanium Carbon Fiber Or Equal)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$314.58 / $314.58 / $314.58
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$314.58 / $321.77 / $649.32
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$623.59 / $685.95 / $1,134.93
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$561.23 / $579.94 / $767.01
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$448.61 / $1,334.48 / $1,334.48
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$389.66 / $1,288.91 / $2,603.19
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$284.45 / $903.75 / $1,180.20
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$200.84 / $471.87 / $717.13
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$357.05 / $623.59 / $748.31
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$314.58 / $623.59 / $3,225.13
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$289.94 / $416.66 / $685.96
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $70.00 / $420.83
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$200.84 / $481.31 / $717.13
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$357.05 / $623.59 / $748.31
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$623.59 / $959.67 / $1,866.88
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$389.66 / $1,217.96 / $3,225.13
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$284.45 / $389.66 / $3,687.45
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$623.59 / $623.59 / $623.59
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$497.92 / $623.59 / $623.59
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$243.59 / $374.15 / $534.82