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New York 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
$27.71 / $35.42 / $65.56
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.71 / $41.53 / $51.31
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$81.39 / $83.02 / $162.78
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.30 / $49.30 / $131.38
CDPHP
Facility/Professional
Facility
Modifier
Low / Median / High Price
$63.06 / $67.81 / $67.81
CDPHP
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.81 / $67.81 / $67.81
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 / $61.62
Emblem Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$81.39 / $183.13 / $332.00
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.03 / $61.04 / $146.50
Excellus BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$35.35 / $35.35 / $35.35
Excellus BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.35 / $48.93 / $58.37
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$61.62 / $61.62 / $555.00
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.98 / $48.49 / $121.27
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.07 / $46.22 / $74.45
Univera
Facility/Professional
Facility
Modifier
Low / Median / High Price
$48.93 / $48.93 / $50.85
Univera
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.35 / $48.93 / $51.99