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Michigan rates for HCPCS L1280

Addition to thoracic-lumbar-sacral orthosis (TLSO), (low profile), rib gusset (elastic), each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$60.26 / $60.26 / $60.26
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.67 / $56.23 / $77.62
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $79.43 / $79.43
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$134.90 / $316.23 / $602.56
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.00 / $104.71 / $109.65
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64.57 / $64.57 / $64.57
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$72.44 / $72.44 / $72.44
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$53.70 / $72.44 / $123.03
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$60.26 / $199.53 / $223.87
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$53.70 / $85.11 / $128.82
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$72.44 / $72.44 / $72.44
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$53.70 / $72.44 / $75.86
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$33.11 / $85.11 / $131.83
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.02 / $48.98 / $75.86