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Wisconsin rates for HCPCS L1840

Knee Orthosis Derotation Medial-Lateral Anterior Cruciate Ligament Custom Fabricated

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$571.58 / $571.58 / $571.58
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$536.34 / $571.58 / $1,018.61
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,133.06 / $1,246.36 / $2,062.17
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$979.98 / $1,053.75 / $1,393.66
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$815.12 / $2,424.75 / $2,424.75
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$732.96 / $2,342.40 / $4,729.13
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$535.05 / $1,887.07 / $2,144.40
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$333.63 / $857.37 / $1,303.02
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$648.76 / $1,133.06 / $1,381.17
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$571.58 / $1,133.06 / $5,476.21
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$489.53 / $602.91 / $1,279.20
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $70.00 / $358.62
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$333.63 / $857.37 / $1,303.02
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$648.76 / $1,133.06 / $1,381.17
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,133.06 / $1,743.76 / $3,100.43
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$732.96 / $2,213.00 / $5,476.21
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$535.05 / $732.96 / $6,629.62
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,133.06 / $1,133.06 / $1,133.06
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$904.72 / $1,133.06 / $1,133.06
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,657.40 / $1,657.40 / $1,657.40
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$451.40 / $573.73 / $1,083.44