go back

Washington, DC 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
$113.79 / $113.79 / $113.79
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$113.79 / $113.79 / $113.79
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$223.42 / $256.85 / $256.85
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$203.01 / $203.01 / $203.01
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$149.58 / $149.58 / $454.15
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$135.65 / $203.47 / $261.76