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Massachusetts 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
$177.83 / $177.83 / $177.83
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$120.23 / $177.83 / $288.40
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$257.04 / $288.40 / $1,148.15
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$144.54 / $257.04 / $354.81
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$489.78 / $489.78 / $1,479.11
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$275.42 / $275.42 / $281.84
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$275.42 / $275.42 / $275.42
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$204.17 / $204.17 / $275.42
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.18 / $4,897.79 / $9,772.37
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$229.09 / $229.09 / $346.74
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$190.55 / $190.55 / $190.55
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$257.04 / $288.40 / $1,148.15
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$144.54 / $257.04 / $354.81
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.30 / $208.93 / $416.87
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$144.54 / $229.09 / $316.23