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Wisconsin rates for HCPCS L2397

Addition To Lower Extremity Orthosis Suspension Sleeve

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$74.18 / $74.18 / $74.18
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$62.71 / $76.04 / $119.09
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$147.06 / $161.77 / $267.64
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$127.19 / $136.77 / $180.88
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$105.80 / $314.70 / $314.70
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$92.98 / $303.94 / $614.41
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.88 / $244.92 / $278.31
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.78 / $111.27 / $169.12
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$84.22 / $147.06 / $176.47
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$70.59 / $147.06 / $659.83
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$58.59 / $75.14 / $160.13
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $65.00 / $85.80
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.78 / $111.27 / $169.12
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$84.22 / $147.06 / $176.47
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$147.06 / $226.33 / $379.40
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$92.98 / $287.22 / $659.83
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.88 / $92.98 / $736.96
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$147.06 / $147.06 / $147.06
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$117.44 / $147.06 / $147.06
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.46 / $73.37 / $135.05