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Vermont 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
$602.56 / $870.96 / $977.24
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$891.25 / $891.25 / $1,258.93
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.69 / $660.69 / $933.25
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,348.96 / $1,412.54 / $1,905.46
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$707.95 / $776.25 / $954.99
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$588.84 / $1,096.48 / $3,630.78