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Louisiana 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
$227.05 / $241.02 / $324.68
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$158.74 / $233.50 / $261.98
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$365.65 / $624.65 / $878.04
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$229.24 / $249.17 / $249.17
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 / $278.10
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$124.16 / $197.27 / $295.37