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Maryland rates for HCPCS L1210

Addition to thoracic-lumbar-sacral orthosis (TLSO), (low profile), lateral thoracic extension

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$120.65 / $128.80 / $230.44
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$158.00 / $158.00 / $201.51
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$190.69 / $190.69 / $190.69
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$139.19 / $139.19 / $190.69
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$206.35 / $294.77 / $424.48
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$128.03 / $147.07 / $234.42
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$176.68 / $176.68 / $206.35