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Virginia 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
$722.45 / $872.77 / $872.77
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$722.45 / $872.77 / $1,231.33
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,765.16 / $1,765.16 / $1,874.60
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,138.79 / $1,138.79 / $1,439.05
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
$943.55 / $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 / $1,588.64 / $2,118.19
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$568.52 / $1,085.61 / $2,009.33
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,101.00 / $2,206.44 / $2,940.19
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$967.09 / $1,332.16 / $2,106.69
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$967.09 / $1,332.16 / $2,106.69
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$795.92 / $880.62 / $1,326.54