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Wisconsin rates for HCPCS L1290

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

Facilitymedian $95 · 10th–90th $83$1740%20%40%10th90th$95Professionalmedian $63 · 10th–90th $44$1450%20%10th90th$63$0.1$0.5$2.0$10.0$50.0$200.0$1.0K

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
$46.77 / $46.77 / $46.77
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$40.74 / $47.86 / $79.43
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$95.50 / $95.50 / $158.49
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$89.13 / $89.13 / $107.15
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$60.26 / $218.78 / $467.74
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$44.67 / $134.90 / $181.97
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$46.77 / $77.62 / $117.49
DeanCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$85.11 / $120.23 / $151.36
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$46.77 / $93.33 / $467.74
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$42.66 / $51.29 / $107.15
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$50.12 / $66.07 / $85.11
Network Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$151.36 / $151.36 / $151.36
Network Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$67.61 / $107.15 / $186.21
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$95.50 / $144.54 / $275.42
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$60.26 / $190.55 / $562.34
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$44.67 / $89.13 / $954.99
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$33.88 / $51.29 / $131.83
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$34.67 / $46.77 / $83.18