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Nationwide rates for HCPCS L0455

Thoracic-lumbar-sacral orthosis (TLSO), flexible, provides trunk support, extends from sacrococcygeal junction to above T-9 vertebra, restricts gross trunk motion in the sagittal plane, produces intracavitary pressure to reduce load on the intervertebral disks with rigid stays or panel(s), includes shoulder straps and closures, prefabricated, off-the-shelf

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$120.23 / $181.97 / $331.13
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$120.23 / $173.78 / $281.84
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$239.88 / $316.23 / $794.33
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$213.80 / $251.19 / $416.87
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$275.42 / $275.42 / $1,047.13
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$204.17 / $204.17 / $380.19
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$144.54 / $204.17 / $416.87
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$134.90 / $204.17 / $309.03