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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
$812.83 / $1,071.52 / $1,412.54
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,698.24 / $1,698.24 / $1,698.24
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,174.90 / $1,174.90 / $1,548.82
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$870.96 / $870.96 / $1,380.38
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,621.81 / $1,737.80 / $2,344.23
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$870.96 / $1,096.48 / $1,479.11
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$724.44 / $1,348.96 / $4,365.16