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Wisconsin rates for HCPCS L1230

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$405.48 / $405.48 / $405.48
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$304.12 / $405.48 / $577.58
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$803.78 / $884.16 / $1,462.88
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$723.40 / $747.52 / $988.64
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$578.24 / $1,720.09 / $1,720.09
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$400.16 / $1,661.34 / $3,354.75
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$292.12 / $1,164.83 / $1,521.21
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$206.26 / $608.22 / $924.35
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$460.23 / $668.69 / $964.54
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$357.05 / $803.78 / $3,392.11
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$316.64 / $401.00 / $875.22
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $70.00 / $364.73
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$206.26 / $608.22 / $924.35
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$460.23 / $668.69 / $964.54
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$803.78 / $1,221.97 / $1,917.07
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$400.16 / $1,569.88 / $3,392.11
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$292.12 / $400.16 / $4,239.22
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$803.78 / $803.78 / $803.78
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$803.78 / $803.78 / $803.78
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,024.66 / $1,024.66 / $1,024.66
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$267.33 / $401.00 / $768.58