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Pennsylvania 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
$37.93 / $258.33 / $258.33
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.65 / $41.96 / $55.83
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,000.00 / $8,639.91 / $79,506.39
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.18 / $92.16 / $92.16
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$60.55 / $60.55 / $88.55
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.20 / $44.20 / $77.54
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$81.47 / $88.55 / $168.25
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$25.04 / $25.29 / $424.34
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$62.23 / $62.23 / $64.51
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$52.59 / $52.59 / $258.33
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.64 / $44.39 / $70.18
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.70 / $59.90 / $174.50
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$60.55 / $60.55 / $88.55
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.20 / $44.20 / $108.38
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$65.89 / $87.72 / $87.72
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.89 / $87.72 / $89.11
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.35 / $118.06 / $141.66
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.27 / $45.98 / $80.52