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Washington rates for HCPCS L1120

Addition to cervical-thoracic-lumbar-sacral orthosis (CTLSO), scoliosis orthosis, cover for upright, each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$37.36 / $84.83 / $88.57
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.09 / $37.36 / $88.57
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$48.49 / $145.94 / $237.18
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.22 / $47.07 / $461.43
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$29.64 / $29.64 / $29.64
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.64 / $21.64 / $29.64
Kaiser Permanente
Facility/Professional
Facility
Modifier
Low / Median / High Price
$28.21 / $53.58 / $127.50
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.24 / $52.89 / $95.16
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.20 / $42.45 / $46.69
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$43.95 / $49.84 / $55.38
Pacific Source
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.38 / $49.84 / $55.38
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$48.49 / $62.19 / $108.16
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.97 / $45.97 / $45.97
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$52.71 / $54.08 / $54.08
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.99 / $47.07 / $60.92
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.64 / $24.08 / $42.59
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.90 / $22.90 / $26.20