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Georgia 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
$52.34 / $52.34 / $124.32
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.84 / $55.28 / $87.55
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.91 / $81.56 / $81.56
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$110.21 / $154.29 / $404.47
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.62 / $91.64 / $175.95
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$82.94 / $93.68 / $203.89
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$93.68 / $93.68 / $93.68
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 / $62.81 / $116.94
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$83.76 / $110.21 / $163.66
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.65 / $52.61 / $90.71