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Maryland rates for HCPCS L1240

Addition to thoracic-lumbar-sacral orthosis (TLSO), (low profile), lumbar derotation pad

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.90 / $51.29 / $95.50
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.48 / $52.48 / $67.61
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$63.10 / $63.10 / $63.10
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.71 / $45.71 / $63.10
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$69.18 / $100.00 / $147.91
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$29.51 / $43.65 / $66.07
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.81 / $48.98 / $77.62
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.48 / $52.48 / $83.18