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Utah rates for HCPCS L1250

Addition to thoracic-lumbar-sacral orthosis (TLSO), (low profile), anterior ASIS pad

Facilitymedian $46 · 10th–90th $26–$810%20%40%10th90th$46Professionalmedian $59 · 10th–90th $26–$3980%10%10th90th$59$50.0$100.0$200.0

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Small sample — interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$25.70 / $25.70 / $25.70
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$25.70 / $47.86 / $398.11
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$61.66 / $61.66 / $61.66
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$44.67 / $44.67 / $61.66
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$37.15 / $58.88 / $77.62
Regence BlueShield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$77.62 / $81.28 / $81.28
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$57.54 / $57.54 / $91.20
Select Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$81.28 / $81.28 / $87.10
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$57.54 / $83.18 / $104.71
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$33.88 / $40.74 / $45.71
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$31.62 / $40.74 / $64.57