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Maine rates for HCPCS L1260

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$41.55 / $57.72 / $57.72
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$84.57 / $109.57 / $203.11
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.74 / $54.39 / $54.39
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$66.67 / $71.02 / $71.02
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.84 / $51.84 / $71.02
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.00 / $77.00 / $77.00
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$53.54 / $57.72 / $57.72
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.43 / $77.00 / $105.34