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Pennsylvania 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
$40.15 / $40.15 / $155.41
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.85 / $44.43 / $53.35
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,000.00 / $8,639.91 / $79,506.39
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$74.30 / $97.58 / $97.58
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$61.62 / $61.62 / $81.39
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.98 / $44.98 / $71.27
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$74.88 / $81.39 / $154.63
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.89 / $65.89 / $73.19
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.15 / $40.15 / $155.41
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.85 / $46.14 / $55.78
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$55.10 / $111.00 / $160.40
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$61.62 / $61.62 / $81.39
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.98 / $44.98 / $110.63
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$69.76 / $92.88 / $92.88
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$69.76 / $92.88 / $92.88
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.84 / $48.68 / $81.39