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Wisconsin rates for HCPCS L0629

Lumbar-Sacral Orthosis Flexible Provides Lumbo-Sacral Support Posterior Extends From Sacrococcygeal Junction To T-9 Vertebra Produces Intracavitary Pressure To Reduce Load On The Intervertebral Discs Includes Straps Closures May Include Stays Shoulder Straps Pendulous Abdomen Design Custom Fabricated

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$173.00 / $173.00 / $173.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$173.00 / $173.00 / $173.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$191.84 / $203.52 / $203.52
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$263.02 / $263.02 / $263.02
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$192.01 / $192.01 / $270.92
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$173.00 / $173.00 / $311.39
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$161.19 / $173.00 / $264.69
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$614.21 / $614.21 / $614.21
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $58.40 / $85.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$173.00 / $173.00 / $311.39
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$155.00 / $155.00 / $263.02
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$192.01 / $263.02 / $263.02
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$614.21 / $614.21 / $614.21