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Wyoming 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
$741.31 / $794.33 / $1,288.25
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,584.89 / $1,584.89 / $1,584.89
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,584.89 / $1,584.89 / $1,584.89
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$891.25 / $891.25 / $1,778.28
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.69 / $660.69 / $1,412.54
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$537.03 / $707.95 / $1,318.26
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$645.65 / $724.44 / $1,071.52