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Wisconsin rates for HCPCS L5859

Addition To Lower Extremity Prosthesis Endoskeletal Knee-Shin System Powered And Programmable Flexion/Extension Assist Control Includes Any Type Motor(S)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,836.06 / $8,836.06 / $8,836.06
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7,336.16 / $8,836.06 / $14,803.79
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17,515.82 / $19,267.40 / $31,878.79
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15,764.23 / $16,289.71 / $21,544.45
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12,600.84 / $37,483.85 / $37,483.85
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,812.54 / $38,673.80 / $73,111.82
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8,340.66 / $25,382.81 / $33,150.05
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,836.06 / $13,943.85 / $20,143.18
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17,095.98 / $17,515.82 / $21,018.98
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11,501.68 / $17,515.82 / $81,836.25
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8,144.05 / $11,803.99 / $19,585.91
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $65.00 / $85.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,836.06 / $14,012.66 / $20,143.18
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17,095.98 / $17,515.82 / $21,018.98
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17,515.82 / $26,956.25 / $47,007.29
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,812.54 / $34,210.58 / $81,836.25
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8,340.66 / $9,812.54 / $89,678.01
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17,515.82 / $17,515.82 / $17,515.82
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17,515.82 / $17,515.82 / $17,515.82
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,528.64 / $10,445.82 / $15,529.80