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Wisconsin rates for HCPCS L1280

Addition to thoracic-lumbar-sacral orthosis (TLSO), (low profile), rib gusset (elastic), each

Facilitymedian $107 · 10th–90th $87$1950%50%10th90th$107Professionalmedian $71 · 10th–90th $49$1620%20%10th90th$71$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
$52.48 / $52.48 / $52.48
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$42.66 / $53.70 / $77.62
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$107.15 / $107.15 / $177.83
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$89.13 / $100.00 / $117.49
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$72.44 / $245.47 / $524.81
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$53.70 / $151.36 / $204.17
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$53.70 / $87.10 / $131.83
DeanCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$95.50 / $147.91 / $186.21
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$53.70 / $104.71 / $512.86
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$47.86 / $56.23 / $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
$169.82 / $169.82 / $169.82
Network Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$75.86 / $120.23 / $208.93
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$107.15 / $162.18 / $309.03
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$72.44 / $213.80 / $616.60
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$53.70 / $107.15 / $691.83
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$37.15 / $56.23 / $107.15
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$38.02 / $52.48 / $91.20