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Tennessee 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
$48.83 / $48.83 / $53.35
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$37.01 / $48.83 / $91.38
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.66 / $97.67 / $97.67
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$43.50 / $61.62 / $61.62
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.98 / $44.98 / $61.62
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$160.09 / $434.49 / $439.47
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$453.62 / $461.16 / $610.42
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.84 / $50.46 / $63.59