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Virginia rates for HCPCS L1210

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$120.65 / $145.75 / $145.75
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$120.65 / $145.75 / $168.35
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$294.77 / $294.77 / $313.06
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$176.99 / $176.99 / $222.11
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$158.00 / $158.00 / $201.51
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$157.58 / $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 / $265.30 / $353.74
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$94.94 / $178.93 / $335.56
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$166.00 / $368.48 / $491.02
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$161.50 / $222.47 / $368.48
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$161.50 / $222.47 / $368.48
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$132.91 / $147.07 / $221.53