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Wisconsin rates for HCPCS L4350

Ankle Control Orthosis Stirrup Style Rigid Includes Any Type Interface (E.G. Pneumatic Gel)Prefabricated Off-The-Shelf (Revised 01/01/14) D 1/1/04)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$39.90 / $75.00 / $129.88
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.50 / $60.49 / $144.50
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$116.57 / $128.22 / $212.16
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$108.41 / $108.41 / $143.38
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.87 / $139.88 / $249.46
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$116.57 / $122.40 / $165.84
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$68.22 / $241.10 / $487.05
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.80 / $168.75 / $220.63
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$32.44 / $87.63 / $134.06
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.76 / $116.57 / $139.88
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56.14 / $116.57 / $535.05
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46.45 / $59.76 / $126.94
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $65.00 / $85.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$32.44 / $88.22 / $134.06
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.76 / $116.57 / $139.88
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$116.57 / $174.86 / $301.11
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$68.22 / $227.68 / $535.05
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.80 / $68.22 / $835.47
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$116.57 / $116.57 / $116.57
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$93.10 / $116.57 / $116.57
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.34 / $58.16 / $116.57