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Arizona 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
$96.42 / $136.94 / $282.95
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$90.62 / $327.35 / $591.84
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$226.53 / $302.04 / $411.53
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 / $203.01 / $298.13
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$84.12 / $108.83 / $1,140.66
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$160.69 / $186.23 / $292.17
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$170.71 / $186.23 / $292.17