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Wisconsin rates for HCPCS L1710

Legg Perthes Orthotic, (Newington Type), Custom Fabricated

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,204.18 / $1,204.18 / $1,204.18
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,087.85 / $1,204.18 / $2,066.03
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,387.05 / $2,625.76 / $4,344.43
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,148.34 / $2,219.96 / $2,936.07
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,717.24 / $5,108.29 / $5,108.29
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,544.16 / $4,935.26 / $9,963.50
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,127.24 / $3,459.38 / $4,517.68
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$648.64 / $1,806.27 / $2,745.11
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,366.77 / $2,387.05 / $2,864.46
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,122.82 / $2,387.05 / $10,889.05
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$950.97 / $1,195.13 / $2,599.19
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $70.00 / $1,001.74
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$648.64 / $1,806.27 / $2,745.11
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,366.77 / $2,387.05 / $2,864.46
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,387.05 / $3,673.59 / $6,028.22
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,544.16 / $4,662.20 / $10,889.05
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,127.24 / $1,544.16 / $14,954.09
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,387.05 / $2,387.05 / $2,387.05
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,387.05 / $2,387.05 / $2,387.05
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$837.28 / $1,190.86 / $2,387.05