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Wisconsin rates for HCPCS L2116

Ankle Foot Orthosis Fracture Orthosis Tibial Fracture Orthosis Rigid Prefabricated Includes Fitting And Adjustment

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$468.46 / $468.46 / $468.46
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$409.13 / $477.30 / $645.24
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$928.63 / $1,021.49 / $1,690.11
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$835.76 / $863.63 / $1,142.21
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$668.07 / $1,987.27 / $1,987.27
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$501.14 / $1,920.27 / $3,876.79
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$365.83 / $1,345.78 / $1,757.51
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$258.31 / $702.69 / $1,067.92
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$531.72 / $928.63 / $1,114.35
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$447.14 / $928.63 / $4,303.54
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$374.19 / $475.94 / $1,011.17
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $70.00 / $605.14
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$258.31 / $702.69 / $1,067.92
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$531.72 / $928.63 / $1,114.35
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$928.63 / $1,429.14 / $2,400.85
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$501.14 / $1,813.74 / $4,303.54
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$365.83 / $501.14 / $5,650.92
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$928.63 / $928.63 / $928.63
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$741.50 / $928.63 / $928.63
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$333.43 / $466.80 / $928.63