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Arizona rates for HCPCS L1200

Thoracic-lumbar-sacral orthosis (TLSO), inclusive of furnishing initial orthosis only

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$941.42 / $969.04 / $1,714.38
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,812.23 / $1,812.23 / $1,812.23
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$617.90 / $2,232.15 / $4,035.63
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,673.46 / $2,059.64 / $2,651.79
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,184.20 / $1,184.20 / $1,184.20
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$864.47 / $864.47 / $2,499.75
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$568.52 / $1,588.91 / $9,758.87
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$795.13 / $880.62 / $1,432.66
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$746.36 / $880.62 / $1,326.54