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Virginia 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
$39.94 / $48.25 / $48.25
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.94 / $48.25 / $54.42
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$97.58 / $97.58 / $103.63
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.30 / $49.30 / $65.14
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.00 / $52.00 / $66.70
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
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$68.31 / $87.82 / $117.10
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$26.21 / $60.01 / $109.46
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.00 / $121.98 / $162.54
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56.29 / $73.64 / $121.98
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.29 / $73.64 / $121.98
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.86 / $48.68 / $73.31