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New Mexico 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
$144.55 / $144.55 / $144.55
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$144.55 / $221.98 / $1,134.03
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$176.61 / $235.48 / $280.58
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$190.69 / $190.69 / $190.69
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$139.19 / $190.69 / $190.69
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$345.44 / $431.81 / $647.71
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$94.94 / $94.94 / $221.53
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$139.19 / $190.69 / $345.44
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$133.54 / $147.07 / $221.53