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Wisconsin rates for HCPCS L4002

Replacement Strap Any Orthosis Includes All Components Any Length Any Type

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$25.00 / $25.00 / $25.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.00 / $25.00 / $25.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.86 / $26.86 / $27.67
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$65.67 / $74.63 / $147.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.65 / $30.75 / $38.44
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$25.00 / $25.00 / $45.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$25.00 / $90.00 / $90.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.52 / $38.52 / $43.87
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.72 / $55.00 / $85.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$25.00 / $25.00 / $45.00
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$65.00 / $65.00 / $90.00
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.65 / $7.65 / $7.65
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.87 / $43.87 / $43.87