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Virginia 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
$40.78 / $49.26 / $49.26
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.78 / $49.26 / $64.04
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$99.64 / $99.64 / $105.82
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.74 / $51.74 / $68.55
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$53.00 / $53.00 / $68.11
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$53.26 / $71.02 / $71.02
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.84 / $51.84 / $71.02
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$69.75 / $89.68 / $119.57
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$27.45 / $61.28 / $111.78
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.00 / $124.55 / $165.95
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$57.47 / $75.19 / $124.55
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.47 / $75.19 / $124.55
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.31 / $49.70 / $74.87