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Maryland 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
$722.45 / $872.77 / $1,379.88
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$946.00 / $946.00 / $1,206.65
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 / $864.47 / $1,184.20
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,235.60 / $1,765.16 / $2,541.83
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$795.13 / $880.62 / $1,403.70
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,054.46 / $1,057.58 / $1,235.60