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Missouri 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
$45.71 / $45.71 / $52.48
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.90 / $48.98 / $107.15
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.26 / $67.61 / $67.61
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$91.20 / $91.20 / $316.23
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46.77 / $53.70 / $83.18
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$53.70 / $53.70 / $91.20
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.74 / $60.26 / $60.26
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.67 / $44.67 / $60.26
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47.86 / $72.44 / $467.74
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.88 / $44.67 / $933.25
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.74 / $70.79 / $91.20
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.88 / $44.67 / $66.07