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Kansas 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
$248.98 / $322.80 / $325.45
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$160.69 / $163.12 / $248.98
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$412.94 / $412.94 / $412.94
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 / $372.66
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$84.12 / $244.10 / $1,140.66
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$124.16 / $207.44 / $457.89
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.47 / $207.44 / $290.08