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Oklahoma 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
$146.91 / $146.91 / $146.91
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$141.47 / $146.91 / $162.93
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$250.29 / $272.06 / $272.06
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 / $278.10 / $278.10
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$84.12 / $154.26 / $1,140.66
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$124.16 / $200.83 / $361.67
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$124.16 / $197.27 / $292.17