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Maine rates for HCPCS L1250

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$41.53 / $57.68 / $57.68
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$84.53 / $109.51 / $203.01
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.30 / $51.95 / $51.95
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$61.62 / $61.62 / $69.84
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.98 / $44.98 / $61.62
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$76.95 / $76.95 / $76.95
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$53.51 / $57.68 / $57.68
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.61 / $47.41 / $109.04