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Iowa rates for HCPCS L1210

Addition to thoracic-lumbar-sacral orthosis (TLSO), (low profile), lateral thoracic extension

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$204.82 / $204.82 / $285.95
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$121.32 / $177.05 / $263.27
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$190.69 / $190.69 / $324.26
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$190.69 / $341.63 / $427.03
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$280.04 / $338.27 / $365.49
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$185.18 / $378.78 / $1,539.25
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$140.93 / $166.15 / $402.76
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$323.32 / $324.26 / $447.83
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$288.00 / $378.78 / $619.66
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$140.93 / $147.07 / $378.18
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$288.88 / $288.88 / $288.88
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$228.22 / $288.88 / $288.88