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New Mexico rates for HCPCS L1200

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$995.47 / $995.47 / $995.47
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$995.47 / $1,528.76 / $6,790.58
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,216.28 / $1,621.70 / $1,932.28
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 / $1,184.20 / $1,184.20
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,624.08 / $2,030.10 / $3,045.15
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$568.52 / $568.52 / $1,525.64
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$864.47 / $1,184.20 / $2,464.17
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$799.60 / $880.62 / $1,326.54