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Virginia rates for HCPCS L1110

Addition to cervical-thoracic-lumbar-sacral orthosis (CTLSO) or scoliosis orthosis, ring flange, plastic or leather, molded to patient model

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$117.76 / $142.27 / $142.27
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$117.76 / $142.27 / $206.06
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$287.73 / $287.73 / $305.57
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$175.24 / $175.24 / $227.68
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$154.00 / $154.00 / $196.69
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$225.30 / $225.30 / $225.30
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$164.47 / $164.47 / $225.30
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$201.41 / $258.95 / $345.28
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$92.67 / $176.96 / $327.54
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$174.00 / $359.66 / $479.27
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$157.63 / $217.14 / $359.66
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$157.63 / $217.14 / $359.66
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$383.64 / $383.64 / $460.37
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$129.74 / $143.54 / $216.23