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Vermont 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
$1,022.50 / $1,022.50 / $1,179.81
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,695.21 / $1,695.21 / $1,695.21
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 / $1,099.29 / $1,388.66
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,184.20 / $1,184.20 / $1,540.04
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$864.47 / $1,184.20 / $1,388.66
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$799.60 / $1,687.87 / $1,742.23