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Wisconsin rates for HCPCS L1200

Thoracic-lumbar-sacral orthosis (TLSO), inclusive of furnishing initial orthosis only

Facilitymedian $2,188 · 10th–90th $1,778$3,9810%50%10th90th$2,188Professionalmedian $1,514 · 10th–90th $912$3,3110%10%20%10th90th$1,514$2.0$10.0$50.0$200.0$1.0K$5.0K

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
$1,096.48 / $1,096.48 / $1,096.48
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$891.25 / $1,096.48 / $1,698.24
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,187.76 / $2,187.76 / $3,630.78
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,995.26 / $2,041.74 / $2,454.71
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,174.90 / $5,011.87 / $10,715.19
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$870.96 / $3,090.30 / $4,168.69
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,096.48 / $1,778.28 / $2,691.53
DeanCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,949.84 / $2,630.27 / $3,235.94
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,096.48 / $2,137.96 / $9,772.37
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$870.96 / $1,071.52 / $2,344.23
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$54.95 / $70.79 / $1,047.13
Network Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$3,467.37 / $3,467.37 / $3,467.37
Network Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,548.82 / $2,454.71 / $4,265.80
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,187.76 / $3,311.31 / $5,495.41
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,174.90 / $4,365.16 / $11,220.18
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$870.96 / $1,737.80 / $14,125.38
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$676.08 / $1,047.13 / $2,187.76
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$724.44 / $1,071.52 / $1,778.28