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Michigan 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
$1,231.33 / $4,833.27 / $5,954.36
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,018.40 / $1,231.33 / $1,231.33
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,617.09 / $1,617.09 / $1,617.09
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,263.43 / $6,502.00 / $11,842.27
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,048.31 / $2,156.12 / $2,910.76
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,147.34 / $1,272.61 / $1,401.48
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,724.90 / $1,724.90 / $1,724.90
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
$999.31 / $1,184.20 / $2,499.75
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,558.12 / $4,833.27 / $5,954.36
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,158.07 / $1,558.12 / $2,263.92
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,308.33 / $1,595.53 / $1,834.85
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$689.52 / $977.66 / $1,440.66