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Nevada 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
$67.63 / $78.03 / $640.08
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.63 / $78.03 / $174.07
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$115.53 / $115.53 / $115.53
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$236.66 / $239.42 / $372.27
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 / $265.94 / $286.44
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$86.65 / $186.23 / $310.39