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Maine 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
$109.05 / $151.50 / $151.50
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$221.99 / $287.60 / $533.12
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$150.94 / $159.28 / $159.28
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$174.97 / $185.61 / $185.61
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$135.50 / $135.50 / $185.61
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$202.08 / $202.08 / $202.08
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$140.54 / $151.50 / $151.50
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$195.26 / $195.26 / $195.26
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$95.94 / $134.32 / $286.35