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Wisconsin rates for HCPCS L1220

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

Facilitymedian $295 · 10th–90th $234$5370%20%40%10th90th$295Professionalmedian $191 · 10th–90th $126$4370%20%10th90th$191$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
$144.54 / $144.54 / $144.54
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$112.20 / $144.54 / $204.17
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$295.12 / $295.12 / $478.63
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$263.03 / $269.15 / $331.13
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$186.21 / $676.08 / $1,445.44
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$134.90 / $416.87 / $549.54
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$144.54 / $234.42 / $363.08
DeanCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$263.03 / $363.08 / $457.09
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$144.54 / $288.40 / $1,348.96
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$123.03 / $147.91 / $323.59
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$54.95 / $70.79 / $144.54
Network Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$467.74 / $467.74 / $467.74
Network Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$208.93 / $331.13 / $575.44
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$295.12 / $436.52 / $776.25
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$186.21 / $588.84 / $1,584.89
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$134.90 / $269.15 / $1,698.24
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$95.50 / $144.54 / $295.12
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$97.72 / $144.54 / $239.88