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Maine rates for HCPCS L1290

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$41.55 / $57.72 / $57.72
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$84.57 / $109.57 / $203.11
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$53.11 / $56.51 / $56.51
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$60.55 / $60.55 / $69.89
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.20 / $44.20 / $60.55
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.00 / $77.00 / $77.00
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$53.54 / $57.72 / $57.72
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.63 / $47.65 / $109.10