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Wisconsin rates for HCPCS L1210

Addi To Thoracic-Lumbar-Sacral Orthotic (Tlso), (Low Profile), L

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$148.71 / $148.71 / $148.71
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$139.99 / $148.71 / $265.86
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$294.77 / $324.26 / $536.50
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$265.30 / $274.14 / $362.57
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$212.07 / $630.83 / $630.83
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$190.69 / $609.76 / $1,230.22
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$139.19 / $427.03 / $557.89
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$94.94 / $223.07 / $339.00
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$168.78 / $294.77 / $393.04
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$148.71 / $291.92 / $1,539.25
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$133.54 / $171.58 / $332.81
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $70.00 / $312.66
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$94.94 / $223.07 / $339.00
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$168.78 / $294.77 / $393.04
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$294.77 / $453.67 / $882.25
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$190.69 / $575.74 / $1,539.25
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$139.19 / $190.69 / $1,957.34
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$294.77 / $294.77 / $294.77
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$235.37 / $294.77 / $294.77
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$117.44 / $147.30 / $281.88