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California rates for HCPCS L1200

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,060.17 / $1,060.17 / $6,790.58
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$915.51 / $1,060.17 / $6,790.58
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,765.16 / $1,765.16 / $1,765.16
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$805.12 / $3,316.62 / $7,470.87
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,051.83 / $1,138.79 / $2,005.19
Blue Shield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$97.00 / $2,786.40 / $4,975.71
Blue Shield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.00 / $3,122.77 / $7,273.97
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,100.81 / $1,184.20 / $1,258.06
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$864.47 / $864.47 / $1,388.66
Contra Costa Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,237.86 / $1,485.44 / $2,588.91
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,412.13 / $1,647.49 / $3,577.40
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,369.63 / $11,179.36 / $11,179.36
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13,813.65 / $14,145.17 / $14,145.17
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,161.70 / $4,161.70 / $4,161.70
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$568.52 / $2,034.02 / $2,387.76
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$864.47 / $1,184.20 / $2,240.15
Sutter Health Plus
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,442.25 / $4,442.25 / $4,442.25
The Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,237.86 / $1,882.84 / $1,882.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$799.60 / $882.06 / $2,374.55