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Maine 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
$915.51 / $1,271.83 / $1,271.83
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,863.58 / $2,414.44 / $4,475.60
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,126.50 / $1,126.50 / $1,138.79
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,184.20 / $1,184.20 / $1,540.04
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$864.47 / $864.47 / $1,184.20
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,696.50 / $1,696.50 / $1,696.50
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,179.81 / $1,271.83 / $1,271.83
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$696.89 / $1,045.33 / $2,403.96