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California rates for HCPCS L1220

Addi To Thoracic-Lumbar-Sacral Orthotic (Tlso), (Low Profile), A

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$149.90 / $149.90 / $992.70
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$123.53 / $149.90 / $960.18
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$249.59 / $249.59 / $249.59
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$113.84 / $468.97 / $1,056.38
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$139.97 / $150.94 / $266.83
Blue Shield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$97.00 / $393.98 / $703.53
Blue Shield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.00 / $441.55 / $1,028.52
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$155.65 / $185.61 / $185.61
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$135.50 / $135.50 / $197.87
Contra Costa Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$139.61 / $167.53 / $366.07
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$199.67 / $232.95 / $515.82
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$529.33 / $1,580.75 / $1,580.75
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,673.42 / $1,713.56 / $2,495.92
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$856.67 / $856.67 / $856.67
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$80.38 / $285.27 / $332.79
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$135.50 / $185.61 / $290.62
Sutter Health Plus
Facility/Professional
Professional
Modifier
Low / Median / High Price
$628.13 / $628.13 / $628.13
The Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$139.61 / $237.34 / $266.23
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$195.26 / $195.26 / $195.26
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$113.06 / $124.52 / $302.39