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Wisconsin rates for HCPCS L2795

Addition To Lower Extremity Orthosis Knee Control Full Kneecap

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$49.85 / $49.85 / $49.85
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.46 / $57.49 / $68.66
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$98.82 / $108.70 / $179.85
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$88.93 / $91.90 / $121.54
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$71.08 / $211.47 / $211.47
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$62.81 / $204.51 / $412.87
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.85 / $142.97 / $187.01
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.83 / $74.78 / $113.64
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.56 / $98.82 / $127.64
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$49.85 / $100.35 / $501.46
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.15 / $55.72 / $111.52
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46.17 / $56.31 / $85.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.83 / $74.78 / $113.64
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.56 / $98.82 / $127.64
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$98.82 / $152.08 / $287.06
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$62.81 / $193.00 / $501.46
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.85 / $62.81 / $706.59
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$98.82 / $98.82 / $98.82
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$78.88 / $98.82 / $98.82
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.36 / $53.02 / $98.82