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Wisconsin rates for HCPCS L1640

Hip Orthosis Abduction Control Of Hip Joints Static Pelvic Band Or Spreader Bar Thigh Cuffs Custom-Fabricated

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$287.73 / $287.73 / $287.73
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$246.87 / $287.73 / $468.85
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$570.38 / $627.41 / $1,038.08
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$513.34 / $530.45 / $701.56
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$410.32 / $1,220.60 / $1,220.60
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$379.04 / $1,179.17 / $2,380.66
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$276.70 / $949.95 / $1,079.49
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$167.43 / $431.60 / $655.94
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$326.57 / $519.84 / $684.46
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$287.73 / $570.38 / $2,777.77
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$239.78 / $302.57 / $621.07
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $70.00 / $303.95
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$167.43 / $431.60 / $655.94
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$326.57 / $519.84 / $684.46
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$570.38 / $877.78 / $1,555.74
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$379.04 / $1,114.02 / $2,777.77
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$276.70 / $379.04 / $3,176.29
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$570.38 / $570.38 / $570.38
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$570.38 / $570.38 / $570.38
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$259.82 / $259.82 / $259.82
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$216.12 / $292.75 / $552.17