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Nebraska 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
$162.18 / $162.18 / $162.18
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$141.25 / $162.18 / $1,445.44
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$229.09 / $251.19 / $251.19
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$186.21 / $186.21 / $288.40
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$186.21 / $331.13 / $478.63
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$165.96 / $288.40 / $1,348.96
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.11 / $128.82 / $275.42
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$281.84 / $281.84 / $645.65
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$288.40 / $288.40 / $288.40
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$354.81 / $645.65 / $645.65
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$95.50 / $147.91 / $288.40
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.11 / $128.82 / $204.17