go back

Rhode Island 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
Professional
Modifier
Low / Median / High Price
$178.21 / $233.74 / $252.18
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$522.16 / $580.19 / $838.08
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$189.93 / $223.45 / $289.45
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
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$146.09 / $203.47 / $339.12