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New Mexico rates for HCPCS L1230

Addition to thoracic-lumbar-sacral orthosis (TLSO), (low profile), Milwaukee type superstructure

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$314.02 / $314.02 / $314.02
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$314.02 / $482.25 / $1,929.35
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$400.16 / $400.16 / $400.16
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$292.12 / $400.16 / $400.16
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$512.32 / $640.41 / $960.61
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$206.26 / $206.26 / $481.27
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$292.12 / $400.16 / $750.48
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$725.80 / $725.80 / $853.88
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$290.10 / $319.49 / $481.27