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Vermont rates for HCPCS L1250

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46.38 / $46.38 / $53.51
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$76.89 / $76.89 / $76.89
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$61.62 / $61.62 / $69.84
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.98 / $61.62 / $65.68
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$61.62 / $61.62 / $69.84
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.98 / $61.62 / $65.68
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.61 / $56.30 / $109.87