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Tennessee 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
$880.84 / $880.84 / $962.40
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$864.53 / $929.78 / $1,648.68
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,166.52 / $1,762.08 / $1,762.08
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$943.55 / $1,184.20 / $1,184.20
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$864.47 / $864.47 / $1,184.20
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,127.85 / $9,758.87 / $11,179.36
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13,813.65 / $14,145.17 / $14,145.17
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$618.61 / $954.01 / $1,326.54