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Wisconsin rates for HCPCS L1720

Legg Perthes Orthosis Trilateral (Tachdijan Type) Custom- Fabricated

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$896.62 / $896.62 / $896.62
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$803.60 / $896.62 / $1,526.17
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,777.39 / $1,955.13 / $3,234.85
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,652.97 / $1,652.97 / $2,186.17
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,278.64 / $3,803.61 / $3,803.61
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,149.77 / $3,674.46 / $7,419.09
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$839.33 / $2,575.78 / $3,363.85
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$478.13 / $1,344.93 / $2,044.00
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,017.69 / $1,777.39 / $2,132.87
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$827.66 / $1,777.39 / $7,860.20
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$734.00 / $886.72 / $1,935.35
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $70.00 / $757.09
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$478.13 / $1,344.93 / $2,044.00
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,017.69 / $1,777.39 / $2,132.87
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,777.39 / $2,735.34 / $4,443.38
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,149.77 / $3,471.46 / $7,860.20
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$839.33 / $1,149.77 / $13,164.93
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,777.39 / $1,777.39 / $1,777.39
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,777.39 / $1,777.39 / $1,777.39
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$617.17 / $886.72 / $1,777.39