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Washington rates for HCPCS L1250

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

Facilitymedian $87 · 10th–90th $58$2000%20%10th90th$87Professionalmedian $59 · 10th–90th $41$1320%10%10th90th$59$1.0$5.0$20.0$100.0$500.0

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$57.54 / $123.03 / $138.04
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$39.81 / $51.29 / $95.50
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$74.13 / $83.18 / $83.18
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$74.13 / $74.13 / $95.50
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
Kaiser Permanente
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$51.29 / $114.82 / $239.88
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$51.29 / $104.71 / $190.55
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$58.88 / $66.07 / $72.44
Pacific Source
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$67.61 / $83.18 / $85.11
Pacific Source
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$67.61 / $85.11 / $85.11
Premera BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$74.13 / $125.89 / $169.82
Premera BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$70.79 / $70.79 / $83.18
Regence BlueShield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$83.18 / $83.18 / $83.18
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$74.13 / $74.13 / $95.50
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$39.81 / $109.65 / $131.83
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$38.02 / $43.65 / $77.62
Wellpoint
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $74.13 / $131.83