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Nebraska 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
$51.90 / $51.90 / $51.90
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.90 / $51.90 / $67.40
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.53 / $78.68 / $79.48
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$61.62 / $89.53 / $89.53
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.62 / $89.53 / $138.28
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47.72 / $90.83 / $434.49
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.99 / $40.61 / $67.68
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$89.27 / $89.53 / $123.65
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$81.06 / $107.30 / $184.44
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.99 / $40.61 / $58.11