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New York 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
$30.20 / $70.79 / $138.04
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$37.15 / $50.12 / $109.65
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$91.20 / $91.20 / $181.97
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.95 / $54.95 / $151.36
CDPHP
Facility/Professional
Facility
Modifier
Low / Median / High Price
$69.18 / $74.13 / $74.13
CDPHP
Facility/Professional
Professional
Modifier
Low / Median / High Price
$74.13 / $74.13 / $74.13
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$60.26 / $162.18 / $50,118.72
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.67 / $44.67 / $97.72
Emblem Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$91.20 / $147.91 / $346.74
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$53.70 / $95.50 / $173.78
Excellus BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.74 / $40.74 / $42.66
Excellus BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.74 / $53.70 / $56.23
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.44 / $72.44 / $72.44
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$87.10 / $50,118.72 / $75,857.76
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$58.88 / $87.10 / $87.10
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$36.31 / $102.33 / $131.83
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.51 / $46.77 / $75.86
Univera
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.74 / $51.29 / $53.70
Univera
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.74 / $53.70 / $56.23