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Wisconsin rates for HCPCS L2760

Addition to lower extremity orthosis, extension, per extension, per bar (for lineal adjustment for growth)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$34.53 / $34.53 / $34.53
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.51 / $34.53 / $61.74
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$68.45 / $75.30 / $124.58
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.60 / $63.66 / $84.19
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$49.24 / $146.47 / $146.47
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$42.77 / $141.66 / $285.51
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.22 / $99.38 / $129.55
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$22.05 / $51.80 / $78.72
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.19 / $68.45 / $91.27
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$34.53 / $68.27 / $365.88
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.01 / $39.84 / $77.27
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.88 / $55.00 / $85.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$22.05 / $51.80 / $78.72
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.19 / $68.45 / $91.27
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$68.45 / $105.35 / $204.75
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$42.77 / $133.69 / $365.88
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.22 / $42.77 / $638.46
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$68.45 / $68.45 / $68.45
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$68.45 / $68.45 / $68.45
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.05 / $33.85 / $39.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.27 / $37.90 / $68.45