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Wisconsin rates for HCPCS L5961

Addition Endoskeletal System Polycentric Hip Joint Pneumatic Or Hydraulic Control With Or Without Flexion And/Or Extension Control

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,906.89 / $2,906.89 / $2,906.89
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,298.42 / $2,906.89 / $4,826.54
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,762.36 / $6,338.60 / $10,487.50
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,046.42 / $5,358.99 / $7,087.70
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,145.43 / $12,331.45 / $12,331.45
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,728.42 / $12,180.30 / $24,052.91
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,721.75 / $8,350.31 / $10,905.71
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,906.89 / $4,609.89 / $6,626.71
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,762.36 / $6,157.35 / $6,914.83
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,762.02 / $5,762.36 / $26,807.65
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,679.23 / $3,856.19 / $6,406.26
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $65.00 / $6,131.93
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,906.89 / $4,686.76 / $6,626.71
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,762.36 / $6,157.35 / $6,914.83
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,762.36 / $8,868.09 / $15,375.68
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,728.42 / $11,254.60 / $26,807.65
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,721.75 / $3,728.42 / $30,647.77
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,762.36 / $5,762.36 / $5,762.36
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,762.36 / $5,762.36 / $5,762.36
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,006.41 / $3,416.67 / $5,109.00