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North Dakota 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
$307.35 / $307.35 / $307.35
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$209.27 / $233.74 / $307.35
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$240.42 / $284.26 / $291.33
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$298.13 / $301.11 / $378.62
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$92.42 / $257.14 / $1,140.66
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$168.30 / $213.71 / $341.65
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$105.53 / $210.76 / $336.60