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Missouri 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
$42.61 / $42.61 / $56.76
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.61 / $44.16 / $67.40
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$81.39 / $85.46 / $375.70
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.27 / $49.30 / $65.84
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$61.62 / $61.62 / $61.62
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.98 / $44.98 / $65.68
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$42.61 / $65.88 / $434.49
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.64 / $40.61 / $98.93
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.29 / $40.61 / $62.14