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Wisconsin rates for HCPCS L2126

Knee Ankle Foot Orthosis Fracture Orthosis Femoral Fracture Cast Orthosis Thermoplastic Type Casting Material Custom- Fabricated

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$776.10 / $776.10 / $776.10
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$727.97 / $776.10 / $1,382.54
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,538.47 / $1,692.32 / $2,800.02
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,384.62 / $1,430.78 / $1,892.31
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,106.78 / $3,292.33 / $3,292.33
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$842.96 / $3,181.02 / $6,421.20
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$615.36 / $2,229.38 / $2,911.68
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$434.49 / $1,164.15 / $1,769.24
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$880.90 / $1,538.47 / $1,846.16
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$752.12 / $1,538.47 / $7,102.37
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$622.27 / $800.56 / $1,675.20
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $70.00 / $922.83
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$434.49 / $1,164.15 / $1,769.24
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$880.90 / $1,538.47 / $1,846.16
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,538.47 / $2,367.66 / $4,037.89
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$842.96 / $3,004.82 / $7,102.37
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$615.36 / $842.96 / $8,633.90
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,538.47 / $1,538.47 / $1,538.47
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,538.47 / $1,538.47 / $1,538.47
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$560.86 / $767.53 / $1,489.49