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Wisconsin rates for HCPCS L1220

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$144.74 / $144.74 / $144.74
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$118.53 / $144.74 / $225.11
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$286.92 / $315.61 / $522.19
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$240.15 / $266.83 / $352.91
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$206.41 / $614.01 / $614.01
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$185.61 / $592.87 / $1,198.03
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$135.50 / $415.78 / $543.03
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$80.38 / $217.11 / $329.96
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$164.29 / $286.92 / $344.30
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$139.15 / $286.92 / $1,347.14
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$115.13 / $148.11 / $312.43
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $70.00 / $143.41
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$80.38 / $217.11 / $329.96
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$164.29 / $286.92 / $344.30
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$286.92 / $441.55 / $746.75
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$185.61 / $560.40 / $1,347.14
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$135.50 / $185.61 / $1,673.42
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$286.92 / $286.92 / $286.92
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$229.11 / $286.92 / $286.92
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$195.26 / $195.26 / $195.26
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.50 / $143.13 / $266.23