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Missouri 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
$1,070.24 / $1,070.24 / $1,425.83
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,070.24 / $1,109.16 / $1,692.92
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,044.40 / $2,146.62 / $9,436.95
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,033.73 / $1,138.79 / $1,654.01
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 / $1,388.66
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$984.12 / $1,654.76 / $9,758.87
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$729.60 / $1,019.93 / $2,484.96
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$729.60 / $1,019.93 / $1,511.96