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Kentucky 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
$29.58 / $55.78 / $57.84
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.26 / $49.89 / $57.84
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$67.55 / $108.52 / $114.05
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46.47 / $47.67 / $50.76
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$81.39 / $141.49 / $161.01
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$96.50 / $130.22 / $179.06
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$61.62 / $61.62 / $127.18
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.98 / $61.62 / $447.49
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.71 / $69.16 / $86.45
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.29 / $48.88 / $67.68