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Wisconsin rates for HCPCS L2000

Knee Ankle Foot Orthosis Single Upright Free Knee Free Ankle Solid Stirrup Thigh And Calf Bands/Cuffs (Single Bar Ak Orthosis) Custom-Fabricated

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$679.94 / $679.94 / $679.94
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$542.65 / $679.94 / $1,030.59
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,347.85 / $1,482.64 / $2,453.09
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,253.50 / $1,253.50 / $1,657.85
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$969.64 / $2,884.40 / $2,884.40
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$714.02 / $2,786.09 / $5,626.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$521.23 / $1,953.28 / $2,550.91
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$368.03 / $1,019.91 / $1,550.03
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$771.74 / $1,347.85 / $1,617.42
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$637.07 / $1,347.85 / $6,061.86
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$536.97 / $678.10 / $1,467.64
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $70.00 / $548.32
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$368.03 / $1,019.91 / $1,550.03
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$771.74 / $1,347.85 / $1,617.42
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,347.85 / $2,074.30 / $3,420.61
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$714.02 / $2,632.52 / $6,061.86
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$521.23 / $714.02 / $10,365.12
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,347.85 / $1,347.85 / $1,347.85
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,076.22 / $1,347.85 / $1,347.85
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$475.06 / $672.43 / $1,218.85