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Wisconsin rates for HCPCS L0648

Lumbar-Sacral Orthosis Sagittal Control With Rigid Anterior And Posterior Panels Posterior Extends From Sacrococcygeal Junction To T-9 Vertebra Produces Intracavitary Pressure To Reduce Load On The Intervertebral Discs Includes Straps Closures May Include Padding Shoulder Straps Pendulous Abdomen Design Prefabricated Off-The-Shelf

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$410.38 / $410.38 / $410.38
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$410.38 / $527.47 / $1,003.42
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$659.19 / $725.11 / $1,199.73
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$613.04 / $659.19 / $823.98
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$889.80 / $1,410.67 / $1,410.67
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$758.68 / $2,448.39 / $3,158.82
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$553.84 / $1,091.46 / $1,240.30
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$249.06 / $615.57 / $791.03
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$342.04 / $659.19 / $791.03
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$410.38 / $761.30 / $3,377.04
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$551.38 / $648.77 / $1,182.69
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $70.00 / $130.78
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$249.06 / $619.52 / $791.03
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$342.04 / $659.19 / $791.03
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$659.19 / $799.84 / $1,510.04
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$758.68 / $1,279.98 / $3,377.04
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$553.84 / $758.68 / $5,142.14
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,006.69 / $1,006.69 / $1,006.69
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,006.69 / $1,006.69 / $1,006.69
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$492.75 / $617.05 / $1,060.80