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Wisconsin rates for HCPCS L2768

Orthotic Side Bar Disconnect Device, Per Bar

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$79.19 / $79.19 / $79.19
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$74.95 / $79.19 / $142.36
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$156.97 / $172.67 / $285.69
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$135.76 / $145.97 / $193.07
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$112.93 / $335.92 / $335.92
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$99.06 / $346.63 / $655.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.31 / $227.34 / $297.08
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$45.17 / $118.79 / $180.52
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.87 / $153.19 / $188.36
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$78.19 / $156.97 / $730.97
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$68.56 / $82.23 / $170.93
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $65.00 / $105.93
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$45.17 / $118.79 / $180.52
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.87 / $153.19 / $188.36
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$156.97 / $241.58 / $419.55
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$99.06 / $306.58 / $730.97
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.31 / $99.06 / $790.38
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$156.97 / $156.97 / $156.97
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$156.97 / $156.97 / $156.97
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$58.30 / $78.31 / $151.97