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Missouri 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
$43.65 / $43.65 / $51.29
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.81 / $51.29 / $102.33
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$58.88 / $58.88 / $64.57
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$87.10 / $87.10 / $302.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.98 / $52.48 / $79.43
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.48 / $52.48 / $87.10
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$38.90 / $70.79 / $70.79
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.29 / $51.29 / $70.79
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$45.71 / $69.18 / $457.09
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $42.66 / $501.19
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$38.90 / $67.61 / $67.61
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $42.66 / $64.57