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Wisconsin rates for HCPCS L0472

Thoracic-lumbar-sacral orthosis (TLSO), triplanar control, hyperextension, rigid anterior and lateral frame extends from symphysis pubis to sternal notch with two anterior components (one pubic and one sternal), posterior and lateral pads with straps and closures, limits spinal flexion, restricts gross trunk motion in sagittal, coronal, and transverse planes, includes fitting and shaping the frame, prefabricated, includes fitting and adjustment

Facilitymedian $501 · 10th–90th $468–$9120%50%10th90th$501Professionalmedian $339 · 10th–90th $229–$7410%20%10th90th$339$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
$245.47 / $245.47 / $245.47
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$223.87 / $245.47 / $363.08
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$501.19 / $501.19 / $812.83
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$446.68 / $467.74 / $549.54
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$295.12 / $1,148.15 / $2,454.71
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$218.78 / $707.95 / $933.25
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$245.47 / $398.11 / $616.60
DeanCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$446.68 / $660.69 / $831.76
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$245.47 / $489.78 / $2,454.71
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$223.87 / $263.03 / $549.54
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$54.95 / $70.79 / $331.13
Network Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$794.33 / $794.33 / $794.33
Network Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$354.81 / $562.34 / $977.24
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$501.19 / $741.31 / $1,445.44
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$295.12 / $1,000.00 / $2,884.03
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$218.78 / $436.52 / $2,951.21
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$154.88 / $263.03 / $501.19
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$177.83 / $245.47 / $416.87