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Idaho 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
$78.03 / $214.65 / $214.65
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 / $136.94 / $225.38
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$103.98 / $154.94 / $172.17
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $247.27 / $293.82
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$167.16 / $167.16 / $324.01
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$120.52 / $125.68 / $180.78
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$175.30 / $186.23 / $295.37