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Massachusetts rates for HCPCS L0472

Thoracic-lumbar-sacral orthosis (TLSO), triplanar control, hyperextension, rigid anterior and lateral frame extends from symphysis pubis to sternal notch with two anterior components (one pubic and one sternal), posterior and lateral pads with straps and closures, limits spinal flexion, restricts gross trunk motion in sagittal, coronal, and transverse planes, includes fitting and shaping the frame, prefabricated, includes fitting and adjustment

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$237.23 / $237.23 / $237.23
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$237.23 / $237.23 / $312.66
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$423.77 / $1,403.95 / $2,885.01
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$212.09 / $388.61 / $530.23
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$355.53 / $355.53 / $367.16
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$297.02 / $297.02 / $399.07
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$216.82 / $297.02 / $565.50
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.43 / $4,618.00 / $9,239.00
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$439.61 / $439.61 / $461.59
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$296.70 / $296.70 / $296.70
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$990.23 / $2,885.01 / $2,885.01
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$189.39 / $270.88 / $530.23
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$192.61 / $270.88 / $530.23