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California rates for HCPCS L1240

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$52.54 / $52.54 / $336.52
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$41.55 / $52.54 / $336.52
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.47 / $87.47 / $87.47
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$39.89 / $164.35 / $370.22
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.62 / $53.19 / $101.91
Blue Shield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$96.60 / $138.09 / $246.59
Blue Shield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.04 / $154.76 / $360.46
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$54.55 / $62.81 / $62.81
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.85 / $45.85 / $66.95
Contra Costa Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.40 / $60.48 / $128.29
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$69.98 / $81.64 / $180.78
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$188.63 / $553.99 / $553.99
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$596.48 / $610.79 / $662.10
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$283.67 / $283.67 / $283.67
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$28.17 / $95.09 / $116.63
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.85 / $62.81 / $91.30
Sutter Health Plus
Facility/Professional
Professional
Modifier
Low / Median / High Price
$220.14 / $220.14 / $220.14
The Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.40 / $85.68 / $93.30
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.61 / $43.64 / $108.21