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Wisconsin rates for HCPCS L1085

Addition to cervical-thoracic-lumbar-sacral orthosis (CTLSO) or scoliosis orthosis, outrigger, bilateral with vertical extensions

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$106.47 / $106.47 / $106.47
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$104.99 / $106.47 / $199.39
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$211.05 / $232.16 / $384.11
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$196.28 / $196.28 / $259.58
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$151.82 / $451.65 / $451.65
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$144.01 / $436.22 / $880.33
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$105.13 / $305.63 / $399.43
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.85 / $159.71 / $242.71
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$120.83 / $211.05 / $253.26
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$96.68 / $211.05 / $928.70
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$84.08 / $105.29 / $229.81
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $65.00 / $99.85
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.85 / $159.71 / $242.71
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$120.83 / $211.05 / $253.26
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$211.05 / $324.77 / $518.91
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$144.01 / $412.20 / $928.70
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$105.13 / $144.01 / $1,217.75
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$211.05 / $211.05 / $211.05
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$211.05 / $211.05 / $211.05
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.09 / $105.29 / $211.05