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Wisconsin rates for HCPCS L5930

Addition Endoskeletal System High Activity Knee Control Frame

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,049.82 / $2,049.82 / $2,049.82
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,701.85 / $2,049.82 / $3,434.20
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,063.39 / $4,469.72 / $7,395.37
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,778.95 / $3,778.95 / $4,997.96
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,923.19 / $8,695.65 / $8,695.65
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,282.71 / $8,400.54 / $16,961.32
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,666.39 / $6,767.44 / $7,690.28
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,176.59 / $3,074.73 / $4,672.89
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,326.60 / $3,965.99 / $4,876.07
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,036.74 / $4,063.39 / $19,065.24
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,847.02 / $2,715.04 / $4,443.21
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $70.00 / $2,625.06
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,176.59 / $3,074.73 / $4,672.89
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,326.60 / $3,965.99 / $4,876.07
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,063.39 / $6,253.41 / $10,935.31
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,282.71 / $7,936.30 / $19,065.24
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,666.39 / $2,282.71 / $20,393.65
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,063.39 / $4,063.39 / $4,063.39
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,244.51 / $4,063.39 / $4,063.39
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,982.23 / $1,982.23 / $1,982.23
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,518.78 / $2,430.05 / $3,602.66