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Alaska rates for HCPCS L1200

Thoracic-lumbar-sacral orthosis (TLSO), inclusive of furnishing initial orthosis only

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,692.72 / $2,692.72 / $2,692.72
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,184.20 / $1,184.20 / $1,184.20
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$864.47 / $1,184.20 / $1,388.66
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$568.52 / $568.52 / $568.52
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,235.87 / $2,986.20 / $4,715.06
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$568.52 / $568.52 / $1,184.20
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$864.47 / $1,388.66 / $2,758.07
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,519.27 / $3,005.71 / $3,920.49