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Alaska rates for HCPCS L0112

Cranial cervical orthosis, congenital torticollis type, with or without soft interface material, adjustable range of motion joint, custom fabricated

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,409.97 / $1,409.97 / $1,409.97
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$941.33 / $941.33 / $941.33
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$687.17 / $941.33 / $969.57
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$485.19 / $485.19 / $485.19
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,563.64 / $1,563.64 / $2,468.91
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$485.19 / $485.19 / $941.33
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$687.17 / $969.57 / $1,622.68
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$795.52 / $1,573.84 / $2,052.84