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Wisconsin rates for HCPCS L1240

Addition to thoracic-lumbar-sacral orthosis (TLSO), (low profile), lumbar derotation pad

Facilitymedian $112 · 10th–90th $91$2040%50%10th90th$112Professionalmedian $63 · 10th–90th $45$1660%20%10th90th$63$0.1$0.5$2.0$10.0$50.0$200.0

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
$54.95 / $54.95 / $54.95
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$41.69 / $54.95 / $81.28
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$112.20 / $112.20 / $186.21
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$100.00 / $104.71 / $125.89
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$63.10 / $257.04 / $549.54
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$45.71 / $158.49 / $213.80
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$54.95 / $91.20 / $138.04
DeanCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$100.00 / $131.83 / $162.18
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$54.95 / $109.65 / $467.74
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$43.65 / $54.95 / $120.23
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$50.12 / $70.79 / $85.11
Network Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$177.83 / $177.83 / $177.83
Network Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$79.43 / $125.89 / $218.78
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$112.20 / $165.96 / $275.42
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$63.10 / $223.87 / $549.54
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$45.71 / $91.20 / $616.60
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$33.88 / $51.29 / $112.20
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$36.31 / $54.95 / $91.20