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Wisconsin rates for HCPCS L1690

Combination Bilateral Lumbo-Sacral Hip Femur Orthosis Providing Adduction And Internal Rotation Control Prefabricated Includes Fitting And Adjustment

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,175.34 / $1,175.34 / $1,175.34
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,112.45 / $1,175.34 / $2,112.75
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,329.91 / $2,562.90 / $4,240.43
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,619.40 / $2,166.82 / $2,865.78
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,676.14 / $4,986.01 / $4,986.01
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,300.55 / $4,817.04 / $9,725.57
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$949.40 / $3,880.39 / $4,409.54
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$670.35 / $1,763.03 / $2,679.40
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,334.05 / $2,274.06 / $2,795.89
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,160.41 / $2,329.91 / $10,889.80
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,017.39 / $1,220.49 / $2,536.98
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $70.00 / $1,517.14
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$670.35 / $1,763.03 / $2,679.40
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,334.05 / $2,274.06 / $2,795.89
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,329.91 / $3,585.65 / $6,229.97
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,300.55 / $4,550.60 / $10,889.80
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$949.40 / $1,300.55 / $11,730.04
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,329.91 / $2,329.91 / $2,329.91
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,329.91 / $2,329.91 / $2,329.91
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$813.03 / $1,162.36 / $2,065.73