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Colorado 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
$96.42 / $96.42 / $96.42
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$96.42 / $160.69 / $233.97
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$172.17 / $193.45 / $351.23
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$239.42 / $258.57 / $328.83
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
Denver HMP
Facility/Professional
Facility
Modifier
Low / Median / High Price
$84.12 / $96.42 / $429.83
Denver HMP
Facility/Professional
Professional
Modifier
Low / Median / High Price
$84.12 / $84.12 / $84.12
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.68 / $215.21 / $344.34
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$175.30 / $186.23 / $292.17