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Wisconsin rates for HCPCS L1260

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

Facilitymedian $115 · 10th–90th $93$2090%20%40%10th90th$115Professionalmedian $65 · 10th–90th $43$1740%20%10th90th$65$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
$57.54 / $57.54 / $57.54
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$40.74 / $57.54 / $79.43
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$114.82 / $114.82 / $190.55
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$104.71 / $107.15 / $128.82
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$70.79 / $269.15 / $575.44
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$51.29 / $165.96 / $218.78
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$53.70 / $93.33 / $144.54
DeanCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$102.33 / $123.03 / $151.36
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$57.54 / $114.82 / $457.09
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$42.66 / $56.23 / $123.03
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
$181.97 / $181.97 / $181.97
Network Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$81.28 / $131.83 / $229.09
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$114.82 / $173.78 / $269.15
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$70.79 / $229.09 / $478.63
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$51.29 / $93.33 / $512.86
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$33.11 / $50.12 / $114.82
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$38.02 / $56.23 / $93.33