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Alaska 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
Professional
Modifier
Low / Median / High Price
$335.01 / $335.01 / $335.01
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$278.10 / $278.10 / $278.10
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$203.01 / $278.10 / $286.44
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$84.12 / $84.12 / $84.12
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$109.75 / $368.03 / $581.10
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$173.40 / $173.40 / $377.27
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$271.83 / $377.27 / $821.35
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$84.12 / $84.12 / $278.10
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$203.01 / $290.44 / $452.72
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$197.12 / $305.20 / $508.68