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Arizona rates for HCPCS L1220

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$123.53 / $133.12 / $218.55
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$87.37 / $315.62 / $570.62
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$218.42 / $291.23 / $393.16
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$185.61 / $185.61 / $185.61
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$135.50 / $135.50 / $332.63
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$80.38 / $223.28 / $1,347.14
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$112.43 / $124.52 / $187.56
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$195.26 / $195.26 / $195.26
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$112.43 / $124.52 / $187.56