go back

Vermont rates for HCPCS L0457

Thoracic-lumbar-sacral orthosis (TLSO), flexible, provides trunk support, thoracic region, rigid posterior panel and soft anterior apron, extends from the sacrococcygeal junction and terminates just inferior to the scapular spine, restricts gross trunk motion in the sagittal plane, produces intracavitary pressure to reduce load on the intervertebral disks, includes straps and closures, prefabricated, off-the-shelf

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$248.48 / $595.02 / $686.56
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$702.09 / $702.09 / $702.09
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$736.58 / $736.58 / $761.97
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$537.70 / $537.70 / $537.70
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$736.58 / $736.58 / $761.97
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$537.70 / $537.70 / $537.70
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$404.56 / $915.42 / $1,408.20