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Wisconsin rates for HCPCS L1250

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

Facilitymedian $98 · 10th–90th $78$1780%20%40%10th90th$98Professionalmedian $59 · 10th–90th $41$1450%20%10th90th$59$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
$47.86 / $47.86 / $47.86
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$39.81 / $47.86 / $66.07
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$97.72 / $97.72 / $162.18
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$91.20 / $91.20 / $107.15
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$61.66 / $223.87 / $478.63
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$44.67 / $138.04 / $181.97
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$47.86 / $77.62 / $120.23
DeanCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$87.10 / $114.82 / $144.54
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$47.86 / $95.50 / $436.52
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$39.81 / $47.86 / $104.71
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$38.90 / $58.88 / $85.11
Network Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$154.88 / $154.88 / $154.88
Network Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$69.18 / $109.65 / $190.55
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$97.72 / $144.54 / $257.04
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$61.66 / $194.98 / $436.52
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$44.67 / $89.13 / $457.09
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$31.62 / $45.71 / $97.72
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$31.62 / $47.86 / $79.43