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Wisconsin rates for HCPCS L2040

Hip-knee-ankle-foot orthosis (HKAFO), torsion control, bilateral rotation straps, pelvic band/belt, custom fabricated

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$122.97 / $122.97 / $122.97
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.71 / $122.97 / $185.56
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$243.75 / $268.13 / $443.63
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$219.37 / $226.69 / $299.81
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$175.35 / $521.63 / $521.63
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$142.94 / $503.75 / $1,017.48
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$104.35 / $353.44 / $461.33
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64.42 / $184.46 / $280.31
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$139.55 / $200.02 / $292.50
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$111.51 / $243.75 / $1,059.51
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.10 / $121.60 / $265.42
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $70.00 / $159.36
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64.42 / $184.46 / $280.31
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$139.55 / $200.02 / $292.50
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$243.75 / $375.11 / $599.21
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$142.94 / $476.08 / $1,059.51
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$104.35 / $142.94 / $1,294.30
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$243.75 / $243.75 / $243.75
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$243.75 / $243.75 / $243.75
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$81.06 / $121.60 / $243.75