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Wisconsin rates for HCPCS L1906

Ankle Foot Orthosis Multiligamentous Ankle Support Prefabricated Off-The-Shelf (Desc Revised 1/1/2017)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$68.34 / $68.34 / $68.34
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$68.34 / $81.37 / $226.20
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$135.49 / $149.04 / $246.59
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$126.01 / $126.01 / $166.65
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$97.47 / $289.95 / $289.95
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$86.88 / $280.49 / $565.41
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.42 / $196.41 / $256.41
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$43.64 / $101.84 / $155.81
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.58 / $135.49 / $180.65
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$68.34 / $135.49 / $722.40
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.37 / $78.86 / $152.96
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $65.00 / $85.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$43.64 / $102.53 / $155.81
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.58 / $135.49 / $180.65
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$135.49 / $208.51 / $405.49
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$86.88 / $264.62 / $722.40
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.42 / $86.88 / $1,283.27
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$135.49 / $135.49 / $135.49
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$108.19 / $135.49 / $135.49
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$53.98 / $67.59 / $126.61