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Missouri 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
$157.40 / $180.29 / $325.45
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$141.24 / $163.12 / $248.98
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$257.14 / $270.00 / $1,186.96
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$195.28 / $251.58 / $346.47
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 / $203.01 / $286.44
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$115.53 / $257.14 / $1,140.66
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$146.09 / $207.44 / $505.42
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$146.09 / $207.44 / $352.15