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Michigan 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
$54.42 / $54.42 / $54.42
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46.20 / $54.42 / $54.42
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$144.22 / $287.36 / $523.37
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$90.53 / $95.29 / $128.63
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$61.94 / $63.43 / $70.54
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$76.23 / $76.23 / $76.23
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$61.62 / $61.62 / $61.62
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.62 / $61.62 / $110.63
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$54.42 / $68.84 / $68.84
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.18 / $68.84 / $100.05
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.81 / $70.51 / $81.08
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.84 / $44.74 / $64.40