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Iowa rates for HCPCS L1260

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$62.00 / $78.95 / $78.95
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$41.00 / $53.54 / $99.62
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$71.02 / $71.02 / $93.75
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.02 / $131.63 / $164.53
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$83.37 / $104.80 / $113.64
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$53.54 / $109.51 / $457.61
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.75 / $48.04 / $116.44
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$93.47 / $93.75 / $129.47
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$76.79 / $110.80 / $179.15
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.75 / $42.52 / $111.78
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.53 / $83.53 / $83.53
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.98 / $83.53 / $83.53