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Wisconsin rates for HCPCS L0452

Tlso Flexible Provides Trunk Support Upper Thoracic Region Produces Intracavitary Pressure To Reduce Load On The Intevertebral Disks With Rigid S Tays Or Panel(S) Includes Shoulder Straps And Closures Custom Fabricated

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$140.00 / $140.00 / $140.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$140.00 / $140.00 / $140.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$241.75 / $266.75 / $288.08
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$223.29 / $223.29 / $223.29
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$163.00 / $163.00 / $223.29
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$140.00 / $140.00 / $252.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$140.00 / $210.00 / $285.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$152.77 / $199.09 / $292.81
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $65.00 / $257.17
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$140.00 / $140.00 / $252.00
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$70.00 / $237.60 / $285.00
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$163.00 / $223.29 / $223.29
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$127.98 / $184.87 / $291.29