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Washington, DC rates for HCPCS L0452

Thoracic-lumbar-sacral orthosis (TLSO), flexible, provides trunk support, upper thoracic region, produces intracavitary pressure to reduce load on the intervertebral disks with rigid stays or panel(s), includes shoulder straps and closures, custom fabricated

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$140.00 / $140.00 / $140.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$140.00 / $140.00 / $140.00
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$223.33 / $223.33 / $223.33
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$163.00 / $163.00 / $163.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$99.26 / $127.98 / $223.70