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Wisconsin rates for HCPCS L1920

Ankle Foot Orthosis Single Upright With Static Or Adjustable Stop (Phelps Or Perlstein Type) Custom-Fabricated

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$249.69 / $249.69 / $249.69
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$187.04 / $249.69 / $355.22
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$494.96 / $544.46 / $900.83
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$428.08 / $460.31 / $608.79
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$356.07 / $1,059.21 / $1,059.21
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$246.11 / $1,023.46 / $2,065.76
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$179.66 / $717.19 / $936.75
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$126.85 / $374.54 / $569.20
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$283.39 / $410.71 / $593.95
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$219.58 / $494.96 / $2,095.14
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$194.74 / $246.93 / $538.95
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $70.00 / $212.74
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$126.85 / $374.54 / $569.20
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$283.39 / $410.71 / $593.95
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$494.96 / $752.04 / $1,179.34
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$246.11 / $966.72 / $2,095.14
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$179.66 / $246.11 / $2,498.81
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$494.96 / $494.96 / $494.96
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$395.21 / $494.96 / $494.96
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$164.62 / $246.93 / $494.96