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Wisconsin rates for HCPCS L5828

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,794.54 / $1,794.54 / $1,794.54
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,411.94 / $1,794.54 / $2,979.62
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,557.34 / $3,913.07 / $6,474.36
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,076.74 / $3,308.33 / $4,375.52
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,559.14 / $7,612.71 / $7,612.71
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,117.90 / $7,354.58 / $14,847.97
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,546.07 / $5,924.63 / $6,732.54
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,091.64 / $2,691.81 / $4,090.94
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,036.84 / $3,557.34 / $4,390.54
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,794.54 / $3,557.34 / $17,754.05
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,654.00 / $2,376.90 / $4,016.16
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $70.00 / $2,400.67
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,091.64 / $2,745.65 / $4,090.94
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,036.84 / $3,557.34 / $4,390.54
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,557.34 / $5,474.61 / $10,146.40
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,117.90 / $6,947.92 / $17,754.05
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,546.07 / $2,117.90 / $21,074.59
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,557.34 / $3,557.34 / $3,557.34
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,840.44 / $3,557.34 / $3,557.34
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,417.20 / $2,234.46 / $3,050.97