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New Jersey 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
$144.61 / $144.61 / $144.61
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$120.72 / $159.61 / $233.74
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$230.13 / $278.10 / $278.10
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$203.01 / $203.01 / $298.13
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$211.72 / $253.14 / $372.61
Horizon BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$230.13 / $339.12 / $339.12
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$160.69 / $203.47 / $335.07