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Arizona rates for HCPCS L1250

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$37.01 / $47.92 / $95.03
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.23 / $71.23 / $71.23
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$24.29 / $87.74 / $158.63
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.73 / $80.97 / $110.32
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$61.62 / $61.62 / $61.62
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.98 / $44.98 / $110.63
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$26.21 / $64.47 / $434.49
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.67 / $40.61 / $61.17
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.70 / $40.61 / $61.17