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Wisconsin rates for HCPCS L1000

Cervical-Thoracic-Lumbar-Sacral Orthosis (Ctlso) (Milwaukee) Inclusive Of Furnishing Initial Orthosis Including Model

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,232.49 / $1,232.49 / $1,232.49
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,086.19 / $1,232.49 / $2,062.86
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,443.17 / $2,687.50 / $4,446.59
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,198.86 / $2,272.16 / $3,005.11
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,757.62 / $5,228.41 / $5,228.41
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,499.97 / $5,051.57 / $10,198.62
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,094.98 / $3,540.47 / $4,623.91
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$736.66 / $1,848.74 / $2,809.66
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,398.92 / $2,443.17 / $3,049.64
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,232.49 / $2,443.17 / $12,090.55
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,055.02 / $1,331.25 / $2,758.34
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $70.00 / $1,215.78
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$736.66 / $1,848.74 / $2,809.66
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,398.92 / $2,443.17 / $3,049.64
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,443.17 / $3,759.98 / $6,846.24
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,499.97 / $4,771.84 / $12,090.55
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,094.98 / $1,499.97 / $16,368.35
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,443.17 / $2,443.17 / $2,443.17
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,443.17 / $2,443.17 / $2,443.17
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$893.45 / $1,218.88 / $2,166.17