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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
$178.21 / $178.21 / $178.21
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$144.61 / $178.21 / $241.02
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$203.81 / $675.22 / $1,140.66
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$146.09 / $254.65 / $314.86
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$489.86 / $489.86 / $1,454.88
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$275.81 / $275.81 / $280.91
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 / $298.13
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.43 / $4,618.00 / $9,239.00
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$330.21 / $330.21 / $346.72
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$191.68 / $191.68 / $191.68
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$503.62 / $1,140.66 / $1,140.66
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$146.09 / $203.47 / $319.22
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$146.09 / $204.52 / $335.07