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Wyoming 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
$1,185.40 / $1,185.40 / $1,853.53
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,067.17 / $2,067.17 / $2,067.17
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,067.17 / $2,067.17 / $2,067.17
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,184.20 / $1,184.20 / $2,248.84
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$864.47 / $864.47 / $1,184.20
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$795.92 / $880.62 / $977.66