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Wisconsin rates for HCPCS L1980

Ankle Foot Orthosis Single Upright Free Plantar Dorsiflexion Solid Stirrup Calf Band/Cuff (Single Bar Bk Orthosis) Custom-Fabricated

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$245.41 / $245.41 / $245.41
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$196.35 / $245.41 / $372.90
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$486.48 / $535.13 / $885.39
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$437.83 / $452.43 / $598.37
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$349.97 / $1,041.07 / $1,041.07
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$273.20 / $1,005.62 / $2,030.77
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$199.44 / $705.00 / $920.70
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$133.16 / $368.12 / $559.45
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$278.56 / $486.48 / $583.78
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$230.52 / $486.48 / $2,218.98
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$193.81 / $245.36 / $529.72
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $70.00 / $230.93
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$133.16 / $368.12 / $559.45
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$278.56 / $486.48 / $583.78
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$486.48 / $748.68 / $1,237.56
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$273.20 / $950.16 / $2,218.98
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$199.44 / $273.20 / $3,204.05
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$486.48 / $486.48 / $486.48
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$388.46 / $486.48 / $486.48
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$171.90 / $242.70 / $431.32