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Wisconsin rates for HCPCS L0112

Cranial Cervical Orthosis Congenital Torticollis Type With Or Without Soft Interface Material Adjustable Range Of Motion Joint Custom Fabricated

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$850.69 / $850.69 / $850.69
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$805.17 / $850.69 / $1,171.71
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,686.33 / $1,854.96 / $3,069.12
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,502.36 / $1,568.29 / $2,074.17
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,213.14 / $3,608.75 / $3,608.75
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$941.33 / $3,722.81 / $7,038.41
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$687.17 / $2,443.59 / $3,191.51
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$485.19 / $1,267.53 / $1,939.28
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$965.56 / $1,645.94 / $2,023.60
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$839.89 / $1,686.33 / $7,852.81
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$736.37 / $883.36 / $1,836.21
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $70.00 / $2,062.42
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$485.19 / $1,276.04 / $1,939.28
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$965.56 / $1,645.94 / $2,023.60
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,686.33 / $2,595.21 / $4,509.62
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$941.33 / $3,293.62 / $7,852.81
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$687.17 / $941.33 / $8,490.04
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,686.33 / $1,686.33 / $1,686.33
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,686.33 / $1,686.33 / $1,686.33
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$626.29 / $841.30 / $1,495.13