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Indiana 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
$47.16 / $47.16 / $95.29
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.26 / $48.98 / $51.70
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.70 / $66.70 / $66.70
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$75.28 / $85.28 / $95.29
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46.47 / $49.30 / $68.03
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$81.00 / $104.82 / $142.94
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$81.00 / $104.82 / $128.63
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$61.62 / $61.62 / $95.29
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.98 / $61.62 / $89.53
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.07 / $45.55 / $63.64