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Wisconsin rates for HCPCS L5920

Addition Endoskeletal System Above Knee Or Hip Disarticulation Alignable System

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$321.26 / $321.26 / $321.26
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$265.29 / $321.26 / $535.33
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$636.84 / $700.52 / $1,159.05
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$573.15 / $592.26 / $783.31
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$458.14 / $1,362.84 / $1,362.84
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$397.94 / $1,317.07 / $2,657.77
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$290.50 / $922.97 / $1,205.28
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$205.11 / $481.89 / $732.37
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$364.63 / $636.84 / $764.21
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$321.26 / $636.84 / $3,385.23
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$296.10 / $425.51 / $700.52
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $70.00 / $407.47
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$205.11 / $491.53 / $732.37
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$364.63 / $636.84 / $764.21
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$636.84 / $980.07 / $1,906.03
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$397.94 / $1,243.83 / $3,385.23
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$290.50 / $397.94 / $4,203.14
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$636.84 / $636.84 / $636.84
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$508.50 / $636.84 / $636.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$264.76 / $423.62 / $636.84