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Wisconsin rates for HCPCS L1001

Cervical Thoracic Lumbar Sacral Orthosis Immobolizer Infant Size

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$45.60 / $45.60 / $45.60
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.60 / $45.60 / $57.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,142.00 / $1,142.74 / $1,142.74
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$45.60 / $45.60 / $82.08
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$45.60 / $45.60 / $82.08
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $65.00 / $808.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$45.60 / $45.60 / $82.08
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$65.00 / $70.00 / $80.00