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Wisconsin rates for HCPCS L2650

Addition To Lower Extremity Pelvic And Thoracic Control Gluteal Pad Each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$84.11 / $84.11 / $84.11
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.20 / $84.11 / $121.93
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$166.73 / $183.40 / $303.45
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$150.05 / $155.06 / $205.07
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$119.94 / $356.80 / $356.80
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$112.36 / $344.29 / $695.58
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$82.02 / $241.41 / $315.55
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$43.54 / $126.17 / $191.74
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$95.46 / $150.63 / $200.08
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$75.38 / $166.73 / $701.53
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.42 / $83.18 / $181.54
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $65.00 / $85.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$43.54 / $126.17 / $191.74
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$95.46 / $150.63 / $200.08
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$166.73 / $256.58 / $404.49
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$112.36 / $325.64 / $701.53
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$82.02 / $112.36 / $892.29
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$166.73 / $166.73 / $166.73
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$166.73 / $166.73 / $166.73
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.21 / $83.18 / $166.73