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Arizona rates for HCPCS L1290

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.22 / $49.71 / $98.57
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$90.91 / $90.91 / $90.91
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$31.00 / $111.99 / $202.47
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.48 / $103.32 / $139.47
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$60.55 / $60.55 / $60.55
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.20 / $44.20 / $108.38
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$28.52 / $78.89 / $470.06
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.89 / $44.18 / $66.54
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.92 / $44.18 / $66.54