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Indiana rates for HCPCS L1240

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$54.24 / $54.24 / $109.58
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.64 / $54.24 / $58.86
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$76.70 / $76.70 / $76.70
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$86.57 / $98.07 / $109.58
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.22 / $52.62 / $72.61
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$82.66 / $120.54 / $164.37
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$93.14 / $120.54 / $147.93
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$62.81 / $62.81 / $109.58
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.85 / $62.81 / $96.23
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.10 / $51.91 / $70.00