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Missouri 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
$135.27 / $135.27 / $180.22
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$135.27 / $140.19 / $213.97
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$258.39 / $271.31 / $1,192.73
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$141.82 / $150.94 / $209.05
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 / $197.87
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$135.27 / $209.15 / $1,347.14
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$103.16 / $128.91 / $314.07
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$195.26 / $195.26 / $195.26
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.50 / $128.91 / $214.39