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Wisconsin rates for HCPCS L1830

Knee orthosis (KO), immobilizer, canvas longitudinal, prefabricated, off-the-shelf

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$35.13 / $45.11 / $243.67
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.73 / $58.00 / $149.25
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$68.89 / $75.78 / $125.38
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.06 / $64.06 / $84.73
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$68.89 / $82.67 / $147.41
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$68.89 / $72.33 / $105.28
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$67.14 / $207.31 / $281.31
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.01 / $98.44 / $129.61
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$31.74 / $58.85 / $82.60
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.38 / $61.52 / $82.67
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$39.22 / $71.25 / $340.47
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.14 / $57.37 / $92.11
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.23 / $55.00 / $85.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$31.74 / $60.02 / $82.60
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.38 / $61.52 / $82.67
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$68.89 / $123.49 / $182.67
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$67.14 / $133.76 / $340.47
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.01 / $67.14 / $612.72
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.71 / $87.71 / $87.71
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$80.02 / $87.71 / $94.14
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$37.89 / $50.00 / $85.96