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Virginia rates for HCPCS L1230

Addition to thoracic-lumbar-sacral orthosis (TLSO), (low profile), Milwaukee type superstructure

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$295.43 / $356.90 / $356.90
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$295.43 / $356.90 / $431.72
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$721.83 / $721.83 / $766.58
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$375.02 / $375.02 / $499.33
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$387.00 / $387.00 / $387.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$400.16 / $400.16 / $400.16
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$292.12 / $292.12 / $400.16
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$505.28 / $649.65 / $866.20
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$206.26 / $437.08 / $806.53
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$360.00 / $902.29 / $1,202.33
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$395.47 / $542.46 / $902.29
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$395.47 / $542.46 / $902.29
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$853.88 / $853.88 / $1,024.66
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$295.39 / $360.11 / $541.07