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Indiana 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
$46.34 / $46.34 / $93.62
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46.34 / $48.12 / $51.58
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.53 / $65.53 / $76.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$73.95 / $83.79 / $93.62
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.67 / $53.11 / $73.29
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$79.58 / $102.98 / $140.43
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.58 / $102.98 / $126.39
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$60.55 / $60.55 / $93.62
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.20 / $60.55 / $96.04
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$141.66 / $141.66 / $141.66
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.45 / $44.76 / $66.54