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Indiana rates for HCPCS L4000

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$788.01 / $788.01 / $1,592.13
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$757.71 / $788.01 / $855.15
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,257.78 / $1,424.96 / $1,592.13
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$776.68 / $874.87 / $1,207.32
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,194.09 / $1,751.34 / $2,228.98
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,353.31 / $1,751.34 / $2,149.38
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$897.58 / $897.58 / $1,592.13
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$655.23 / $655.23 / $1,633.21
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$957.27 / $957.27 / $957.27
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$477.75 / $761.14 / $1,079.50