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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
$141.25 / $177.83 / $562.34
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$549.54 / $602.56 / $831.76
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$165.96 / $223.87 / $338.84
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$275.42 / $275.42 / $275.42
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$204.17 / $204.17 / $275.42
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$186.21 / $234.42 / $416.87
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$186.21 / $257.04 / $338.84