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New Mexico 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
$138.04 / $138.04 / $138.04
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$112.20 / $144.54 / $223.87
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,047.13 / $2,238.72 / $3,715.35
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$169.82 / $229.09 / $269.15
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$186.21 / $186.21 / $186.21
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$134.90 / $134.90 / $426.58
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$331.13 / $416.87 / $630.96
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$81.28 / $213.80 / $338.84
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$134.90 / $134.90 / $363.08
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$95.50 / $138.04 / $338.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$112.20 / $125.89 / $186.21