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Massachusetts rates for HCPCS L1220

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$109.05 / $109.05 / $109.05
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$109.05 / $121.29 / $162.32
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$126.42 / $582.45 / $1,580.75
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$112.43 / $190.05 / $243.74
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$144.36 / $144.36 / $428.75
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$163.43 / $205.24 / $205.24
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$144.36 / $183.45 / $185.61
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$135.50 / $185.61 / $332.63
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.43 / $4,618.00 / $9,239.00
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$202.08 / $202.08 / $212.18
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$158.57 / $158.57 / $158.57
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$582.45 / $1,580.75 / $1,580.75
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$95.94 / $133.41 / $243.74
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$195.26 / $195.26 / $195.26
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$103.16 / $133.41 / $243.74