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New Mexico rates for HCPCS L1110

Addition to cervical-thoracic-lumbar-sacral orthosis (CTLSO) or scoliosis orthosis, ring flange, plastic or leather, molded to patient model

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$142.34 / $142.34 / $142.34
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$142.34 / $218.59 / $1,106.90
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$225.30 / $225.30 / $225.30
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$164.47 / $225.30 / $225.30
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$232.21 / $290.27 / $435.40
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$92.67 / $92.67 / $225.30
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$164.47 / $225.30 / $352.56
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$326.08 / $326.08 / $383.64
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$130.34 / $143.54 / $216.23