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Washington, DC 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
$722.45 / $722.45 / $722.45
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$722.45 / $722.45 / $722.45
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$946.00 / $946.00 / $1,206.65
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$864.47 / $864.47 / $864.47
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,147.34 / $1,147.34 / $3,503.95
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$587.08 / $880.62 / $1,323.13