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Wisconsin rates for HCPCS L1940

Ankle-Foot Orthotic (Afo), Plastic Or Other Material, Custom Fab

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$295.99 / $295.99 / $295.99
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$290.17 / $324.58 / $407.68
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$586.74 / $645.41 / $1,067.86
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$507.47 / $545.66 / $721.69
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$422.09 / $1,255.61 / $1,255.61
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$372.88 / $1,212.94 / $2,449.23
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$272.20 / $850.31 / $1,110.45
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$179.44 / $443.99 / $674.75
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$335.94 / $586.74 / $742.87
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$295.99 / $586.74 / $3,004.61
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$261.58 / $324.27 / $662.40
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $70.00 / $285.76
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$179.44 / $443.99 / $674.75
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$335.94 / $586.74 / $742.87
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$586.74 / $902.97 / $1,668.15
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$372.88 / $1,145.98 / $3,004.61
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$272.20 / $372.88 / $3,565.78
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$586.74 / $586.74 / $586.74
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$468.49 / $586.74 / $586.74
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$233.75 / $307.35 / $586.74