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Minnesota 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
$209.27 / $209.27 / $209.27
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$160.69 / $209.27 / $307.35
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$295.70 / $314.79 / $487.86
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$272.06 / $327.92 / $340.07
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$278.10 / $788.33 / $2,189.51
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$298.13 / $316.01 / $378.62
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$468.02 / $756.36 / $1,724.03
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$298.13 / $298.13 / $304.80
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$86.64 / $257.14 / $1,140.66
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$124.16 / $207.96 / $419.62
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$124.16 / $207.96 / $419.62