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Wisconsin rates for HCPCS L4210

Repair of orthotic device, repair or replace minor parts

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19.95 / $19.95 / $19.95
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.95 / $19.95 / $50.12
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.23 / $57.54 / $57.54
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$74.13 / $87.10 / $138.04
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.54 / $34.67 / $117.49
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19.95 / $19.95 / $36.31
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.44 / $81.28 / $104.71
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19.95 / $29.51 / $89.13
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.55 / $28.84 / $28.84
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.12 / $58.88 / $70.79
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64.57 / $64.57 / $100.00
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$117.49 / $117.49 / $117.49
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.92 / $30.90 / $31.62
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.95 / $23.99 / $28.84