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Wisconsin rates for HCPCS L5795

Addition Exoskeletal System Hip Disarticulation Ultra-Light Material (Titanium Carbon Fiber Or Equal)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$650.09 / $650.09 / $650.09
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$650.09 / $715.78 / $1,444.38
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,288.69 / $1,417.56 / $2,345.42
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,114.58 / $1,198.48 / $1,585.08
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$927.08 / $2,757.80 / $2,757.80
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$908.11 / $2,664.16 / $5,378.52
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$662.92 / $2,146.27 / $2,438.94
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$415.05 / $975.14 / $1,481.99
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$737.87 / $1,288.69 / $1,546.43
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$650.09 / $1,288.69 / $6,807.72
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$599.17 / $861.07 / $1,417.56
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $70.00 / $876.46
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$415.05 / $994.64 / $1,481.99
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$737.87 / $1,288.69 / $1,546.43
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,288.69 / $1,983.23 / $3,857.22
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$908.11 / $2,516.96 / $6,807.72
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$662.92 / $908.11 / $8,505.34
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,288.69 / $1,288.69 / $1,288.69
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,288.69 / $1,288.69 / $1,288.69
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,061.90 / $2,061.90 / $2,061.90
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$535.76 / $857.22 / $1,105.24