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Arizona rates for HCPCS L1240

Addition to thoracic-lumbar-sacral orthosis (TLSO), (low profile), lumbar derotation pad

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46.65 / $48.99 / $96.50
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.81 / $89.81 / $89.81
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.62 / $110.60 / $199.96
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$76.55 / $102.06 / $133.96
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$62.81 / $62.81 / $62.81
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.85 / $45.85 / $127.13
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$28.17 / $77.93 / $468.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.40 / $43.64 / $65.73
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.40 / $43.64 / $65.73