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Maine 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
$128.80 / $178.93 / $178.93
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$262.18 / $339.67 / $629.65
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$176.99 / $188.19 / $188.19
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$190.69 / $190.69 / $216.67
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$139.19 / $139.19 / $190.69
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$238.67 / $238.67 / $238.67
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$165.98 / $178.93 / $178.93
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$98.04 / $158.63 / $338.20