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Wisconsin rates for HCPCS L0469

Thoracic-lumbar-sacral orthosis (TLSO), sagittal-coronal control, rigid posterior frame and flexible soft anterior apron with straps, closures and padding, extends from sacrococcygeal junction over scapulae, lateral strength provided by pelvic, thoracic, and lateral frame pieces, restricts gross trunk motion in sagittal and coronal planes, produces intracavitary pressure to reduce load on intervertebral disks, prefabricated, off-the-shelf

Facilitymedian $324 · 10th–90th $316–$5890%50%10th90th$324Professionalmedian $295 · 10th–90th $182–$4790%20%10th90th$295$0.5$2.0$10.0$50.0$200.0$1.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$194.98 / $194.98 / $194.98
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$169.82 / $199.53 / $371.54
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$323.59 / $323.59 / $537.03
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$302.00 / $302.00 / $363.08
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$380.19 / $1,288.25 / $1,819.70
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$281.84 / $537.03 / $616.60
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$194.98 / $316.23 / $467.74
DeanCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$316.23 / $478.63 / $537.03
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$194.98 / $363.08 / $1,659.59
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$257.04 / $302.00 / $645.65
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$54.95 / $70.79 / $416.87
Network Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$302.00 / $501.19 / $794.33
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$263.03 / $389.05 / $724.44
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$380.19 / $645.65 / $1,659.59
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$281.84 / $512.86 / $2,630.27
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$181.97 / $288.40 / $478.63
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$190.55 / $288.40 / $446.68