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Wisconsin rates for HCPCS L1652

Hip Orthosis Bilateral Thigh Cuffs With Adjustable Abductor Spreader Bar Adult Size Prefabricated Includes Fitting And Adjustment Any Type

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$216.66 / $216.66 / $216.66
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$205.07 / $216.66 / $389.47
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$429.50 / $472.45 / $781.69
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$371.47 / $399.44 / $528.28
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$308.98 / $919.13 / $919.13
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$252.01 / $948.75 / $1,792.84
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$183.97 / $622.50 / $812.85
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$123.57 / $324.99 / $493.93
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$245.91 / $419.18 / $515.40
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$213.91 / $429.50 / $2,000.04
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$187.54 / $224.99 / $467.67
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $70.00 / $289.83
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$123.57 / $324.99 / $493.93
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$245.91 / $419.18 / $515.40
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$429.50 / $660.97 / $1,148.23
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$252.01 / $838.86 / $2,000.04
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$183.97 / $252.01 / $2,162.37
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$429.50 / $429.50 / $429.50
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$429.50 / $429.50 / $429.50
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$159.51 / $214.27 / $410.69