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Illinois rates for HCPCS L1290

Addition to thoracic-lumbar-sacral orthosis (TLSO), (low profile), lateral trochanteric pad

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47.86 / $47.86 / $95.50
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.74 / $48.98 / $100.00
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.07 / $67.61 / $67.61
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$112.20 / $181.97 / $645.65
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.23 / $70.79 / $70.79
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$60.26 / $60.26 / $63.10
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.67 / $44.67 / $97.72
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $117.49 / $144.54
Hally Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$123.03 / $123.03 / $123.03
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.98 / $48.98 / $70.79
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$37.15 / $74.13 / $144.54
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.48 / $46.77 / $74.13