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Idaho 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
$927.38 / $2,060.85 / $2,060.85
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,184.20 / $1,184.20 / $1,476.19
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$864.47 / $864.47 / $1,388.66
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$568.52 / $1,657.85 / $2,353.55
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,118.19 / $2,235.87 / $2,353.55
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $1,736.92 / $2,068.55
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,060.85 / $2,298.39 / $3,447.59
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,647.49 / $1,647.49 / $2,471.23
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$814.21 / $880.62 / $1,396.66