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Pennsylvania 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
$41.00 / $41.00 / $158.66
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.35 / $45.36 / $61.03
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,000.00 / $8,639.91 / $79,506.39
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.86 / $99.64 / $99.64
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$71.02 / $71.02 / $85.23
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.84 / $51.84 / $74.63
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$78.41 / $85.23 / $161.94
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.28 / $67.28 / $71.01
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$41.00 / $41.00 / $158.66
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.35 / $47.11 / $75.86
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.70 / $116.20 / $167.90
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$71.02 / $71.02 / $85.23
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.84 / $51.84 / $131.63
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$71.23 / $94.83 / $94.83
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.23 / $94.83 / $108.16
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.04 / $49.70 / $85.23