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North Carolina 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
$95.03 / $95.03 / $163.92
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.26 / $95.03 / $95.03
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$87.00 / $104.40 / $198.26
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.86 / $81.39 / $81.39
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$61.62 / $61.62 / $67.13
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.98 / $61.62 / $110.63
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$26.21 / $94.54 / $123.54
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.00 / $61.00 / $73.79
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.70 / $97.70 / $150.19
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.10 / $51.87 / $76.95
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$169.57 / $439.47 / $439.47
Wellcare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$461.16 / $461.16 / $610.42