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Wisconsin rates for HCPCS L1210

Addition to thoracic-lumbar-sacral orthosis (TLSO), (low profile), lateral thoracic extension

Facilitymedian $302 · 10th–90th $245$5500%20%40%10th90th$302Professionalmedian $204 · 10th–90th $138$4680%20%10th90th$204$0.2$1.0$5.0$20.0$100.0$500.0

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
$147.91 / $147.91 / $147.91
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$131.83 / $151.36 / $257.04
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$302.00 / $302.00 / $501.19
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$257.04 / $281.84 / $338.84
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$190.55 / $691.83 / $1,479.11
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$138.04 / $426.58 / $575.44
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$147.91 / $245.47 / $371.54
DeanCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$269.15 / $416.87 / $524.81
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$147.91 / $295.12 / $1,548.82
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$134.90 / $169.82 / $331.13
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$54.95 / $70.79 / $316.23
Network Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$478.63 / $478.63 / $478.63
Network Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$213.80 / $338.84 / $588.84
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$302.00 / $467.74 / $933.25
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$190.55 / $602.56 / $1,862.09
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$138.04 / $275.42 / $1,949.84
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$112.20 / $169.82 / $302.00
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$114.82 / $147.91 / $263.03