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Indiana rates for HCPCS L1260

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56.24 / $56.24 / $113.64
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.39 / $56.24 / $61.03
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.55 / $79.55 / $93.60
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$89.78 / $101.71 / $113.64
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.91 / $51.74 / $71.40
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$85.23 / $125.00 / $167.31
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$96.59 / $125.00 / $153.41
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$71.02 / $71.02 / $113.64
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.84 / $71.02 / $99.50
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.34 / $52.84 / $73.76