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Michigan rates for HCPCS L1250

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

Facilitymedian $110 · 10th–90th $46–$3890%20%10th90th$110Professionalmedian $51 · 10th–90th $40–$950%20%10th90th$51$0.1$0.5$2.0$10.0$50.0$200.0$1.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$53.70 / $53.70 / $53.70
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$38.90 / $50.12 / $66.07
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$125.89 / $288.40 / $549.54
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$95.50 / $95.50 / $100.00
CareSource
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$70.79 / $70.79 / $70.79
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$61.66 / $61.66 / $61.66
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$44.67 / $61.66 / $100.00
Health Alliance Plan
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$53.70 / $181.97 / $204.17
Health Alliance Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$47.86 / $75.86 / $117.49
Priority Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$61.66 / $61.66 / $61.66
Priority Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$44.67 / $66.07 / $91.20
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$31.62 / $77.62 / $109.65
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$31.62 / $44.67 / $64.57