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Wisconsin rates for HCPCS L0160

Cervical Semi-Rigid Wire Frame Occipital/ Mandibular Support Prefabricated Off-The-Shelf (Revised 01/01/14)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$95.00 / $95.00 / $95.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$95.00 / $98.58 / $179.33
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$188.31 / $207.14 / $342.72
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$169.47 / $175.13 / $231.62
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$135.47 / $402.98 / $402.98
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$121.82 / $389.31 / $786.56
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$88.93 / $272.81 / $356.40
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56.83 / $142.50 / $216.56
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$107.82 / $188.31 / $225.97
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$95.00 / $188.31 / $928.37
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$84.83 / $102.70 / $205.05
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $68.95 / $114.93
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56.83 / $142.50 / $216.56
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$107.82 / $188.31 / $225.97
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$188.31 / $289.79 / $527.95
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$121.82 / $367.80 / $928.37
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$88.93 / $121.82 / $1,164.54
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$188.31 / $188.31 / $188.31
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$188.31 / $188.31 / $188.31
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.02 / $97.88 / $188.31