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Wisconsin rates for HCPCS L2525

Addition to lower extremity, thigh/weight bearing, ischial containment/narrow M-L brim molded to patient model

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$691.83 / $691.83 / $691.83
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$645.65 / $776.25 / $1,288.25
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,412.54 / $1,412.54 / $2,290.87
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,122.02 / $1,288.25 / $1,584.89
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$891.25 / $3,235.94 / $6,918.31
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$645.65 / $1,995.26 / $2,630.27
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$691.83 / $1,122.02 / $1,737.80
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,258.93 / $1,905.46 / $2,398.83
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$707.95 / $1,380.38 / $7,413.10
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$645.65 / $812.83 / $1,659.59
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.95 / $70.79 / $1,000.00
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,412.54 / $2,089.30 / $4,365.16
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$891.25 / $2,818.38 / $8,128.31
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$645.65 / $1,288.25 / $8,128.31
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$630.96 / $794.33 / $2,238.72
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$537.03 / $691.83 / $1,174.90