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Virginia 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
$113.79 / $201.66 / $201.66
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$113.79 / $201.66 / $201.66
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$262.27 / $262.27 / $278.54
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$239.42 / $239.42 / $299.29
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$223.42 / $256.85 / $256.85
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
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$161.09 / $230.13 / $368.58
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$84.12 / $223.45 / $380.31
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$316.83 / $380.00 / $504.05
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$212.28 / $319.22 / $412.03
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$212.28 / $319.22 / $412.03
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$175.30 / $203.47 / $319.22