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Idaho rates for HCPCS L4000

Replace girdle for spinal orthosis (cervical-thoracic-lumbar-sacral orthosis (CTLSO) or spinal orthosis SO)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$754.68 / $1,428.94 / $1,428.94
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$897.58 / $897.58 / $1,201.28
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$655.23 / $655.23 / $1,710.54
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$462.65 / $1,225.16 / $1,631.89
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,468.70 / $1,550.30 / $1,631.89
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $1,204.33 / $1,434.28
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,428.94 / $1,593.64 / $2,390.46
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,142.32 / $1,142.32 / $1,713.48
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$957.27 / $957.27 / $957.27
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$662.59 / $716.63 / $1,104.31