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Wisconsin rates for HCPCS L2108

Ankle Foot Orthosis Fracture Orthosis Tibial Fracture Cast Orthosis Custom-Fabricated

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$698.76 / $698.76 / $698.76
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$571.63 / $698.76 / $1,085.63
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,385.15 / $1,523.67 / $2,520.96
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,288.19 / $1,288.19 / $1,703.73
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$996.47 / $2,964.22 / $2,964.22
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$752.15 / $2,863.97 / $5,781.60
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$549.07 / $2,306.92 / $2,621.51
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$387.68 / $1,048.14 / $1,592.92
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$793.11 / $1,385.15 / $1,662.18
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$671.10 / $1,385.15 / $6,344.91
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$555.23 / $714.32 / $1,508.26
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $70.00 / $806.85
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$387.68 / $1,048.14 / $1,592.92
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$793.11 / $1,385.15 / $1,662.18
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,385.15 / $2,131.71 / $3,603.28
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$752.15 / $2,705.38 / $6,344.91
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$549.07 / $752.15 / $7,124.59
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,385.15 / $1,385.15 / $1,385.15
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,385.15 / $1,385.15 / $1,385.15
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$500.43 / $691.04 / $1,228.09