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Maryland 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
$634.74 / $697.94 / $1,212.34
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$832.00 / $832.00 / $1,060.16
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$897.58 / $897.58 / $897.58
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$655.23 / $655.23 / $655.23
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,085.60 / $1,550.87 / $2,233.25
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$957.27 / $957.27 / $957.27
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$607.37 / $773.71 / $1,233.28
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$860.58 / $860.58 / $1,085.60