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Pennsylvania rates for HCPCS L1001

Cervical-thoracic-lumbar-sacral orthosis (CTLSO), immobilizer, infant size, prefabricated, includes fitting and adjustment

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$45.60 / $45.60 / $176.47
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.60 / $45.60 / $57.00
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,236.69 / $1,236.69 / $1,236.69
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$443.47 / $2,800.00 / $2,800.00
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$45.60 / $176.47 / $326.18
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.60 / $45.60 / $57.00
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$443.47 / $2,800.00 / $2,800.00