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Michigan 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
$62.58 / $295.54 / $363.64
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46.32 / $62.58 / $62.58
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$82.19 / $82.19 / $82.19
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$165.86 / $330.45 / $601.86
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$104.10 / $109.58 / $147.93
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$63.43 / $71.23 / $71.64
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.66 / $87.66 / $87.66
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$62.81 / $62.81 / $62.81
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$62.81 / $62.81 / $127.13
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$79.19 / $295.54 / $363.64
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$55.80 / $79.19 / $115.05
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.49 / $81.09 / $93.25
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.17 / $50.54 / $78.43