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Connecticut 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
$198.23 / $198.23 / $198.23
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$144.19 / $177.49 / $198.23
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$203.27 / $262.27 / $300.07
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$236.66 / $239.42 / $239.42
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 / $278.10
ConnectiCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$170.48 / $170.48 / $170.48
ConnectiCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$149.58 / $170.48 / $222.94
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$191.68 / $191.68 / $191.68
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$146.09 / $203.47 / $291.42