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Tennessee 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
$150.38 / $150.38 / $164.31
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$144.19 / $153.16 / $282.95
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$250.32 / $307.08 / $333.76
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 / $203.01 / $278.10
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$407.44 / $1,140.66 / $1,140.66
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,737.25 / $1,743.30 / $1,743.30
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$139.72 / $200.26 / $292.17