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Louisiana 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
$1,097.19 / $1,164.71 / $1,568.98
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$929.78 / $1,164.71 / $1,265.99
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,766.99 / $3,018.63 / $4,243.10
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,205.03 / $1,441.37 / $1,441.37
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.00 / $40.00 / $40.00
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 / $1,184.20
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$587.08 / $936.41 / $1,357.02