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New Mexico rates for HCPCS L0470

Thoracic-lumbar-sacral orthosis (TLSO), triplanar control, rigid posterior frame and flexible soft anterior apron with straps, closures and padding extends from sacrococcygeal junction to scapula, lateral strength provided by pelvic, thoracic, and lateral frame pieces, rotational strength provided by subclavicular extensions, restricts gross trunk motion in sagittal, coronal, and transverse planes, provides intracavitary pressure to reduce load on the intervertebral disks, includes fitting and shaping the frame, prefabricated, includes fitting and adjustment

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$352.20 / $352.20 / $352.20
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$352.20 / $540.88 / $2,763.13
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$430.32 / $573.76 / $683.65
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$512.80 / $512.80 / $512.80
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$374.35 / $512.80 / $512.80
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$574.60 / $718.26 / $1,077.39
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$231.33 / $231.33 / $539.78
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$374.35 / $512.80 / $841.70
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$325.36 / $358.33 / $539.78