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Iowa rates for HCPCS L1250

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$59.22 / $66.20 / $66.20
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.15 / $51.13 / $96.93
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$61.62 / $61.62 / $89.53
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.62 / $110.63 / $138.28
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.47 / $101.90 / $110.10
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$51.13 / $104.58 / $434.49
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.90 / $45.88 / $111.21
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$89.53 / $90.79 / $123.65
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$73.33 / $105.81 / $171.08
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.90 / $40.61 / $106.77
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$79.76 / $79.76 / $79.76
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.01 / $79.76 / $79.76