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Wisconsin rates for HCPCS L2190

Addition To Lower Extremity Fracture Orthosis Waist Belt

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$51.84 / $51.84 / $51.84
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.84 / $55.49 / $105.38
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$102.77 / $113.05 / $187.04
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$88.88 / $95.58 / $126.40
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$73.93 / $219.93 / $219.93
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$61.48 / $212.96 / $428.27
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.88 / $149.06 / $194.50
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$31.69 / $77.76 / $118.19
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$58.85 / $98.38 / $123.32
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$51.84 / $102.77 / $503.80
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46.30 / $57.27 / $111.91
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.79 / $59.51 / $85.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$31.69 / $77.76 / $118.19
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$58.85 / $98.38 / $123.32
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.77 / $158.16 / $294.08
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$61.48 / $200.72 / $503.80
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.88 / $61.48 / $558.26
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.77 / $102.77 / $102.77
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.77 / $102.77 / $102.77
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$29.60 / $29.60 / $29.60
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.90 / $54.50 / $91.95