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Wisconsin rates for HCPCS L5822

Addition Endoskeletal Knee-Shin System Single Axis Pneumatic Swing Friction Stance Phase Control

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,066.66 / $1,066.66 / $1,066.66
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$851.43 / $1,066.66 / $1,771.06
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,114.46 / $2,325.91 / $3,848.32
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,828.79 / $1,966.45 / $2,600.78
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,521.13 / $4,524.93 / $4,524.93
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,367.82 / $4,371.46 / $8,825.65
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$998.51 / $3,064.22 / $4,001.78
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$658.29 / $1,599.99 / $2,431.63
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,210.69 / $2,043.89 / $2,537.35
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,066.66 / $2,114.46 / $10,228.89
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$983.12 / $1,412.82 / $2,302.38
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $70.00 / $1,397.87
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$658.29 / $1,599.99 / $2,431.63
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,210.69 / $2,043.89 / $2,537.35
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,114.46 / $3,254.08 / $6,118.56
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,367.82 / $4,129.80 / $10,228.89
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$998.51 / $1,367.82 / $12,164.54
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,114.46 / $2,114.46 / $2,114.46
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,114.46 / $2,114.46 / $2,114.46
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.63 / $1,534.46 / $1,536.34
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$842.37 / $1,212.90 / $1,813.47