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Nationwide 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

Facilitymedian $288 · 10th–90th $141–$7940%20%40%10th90th$288Professionalmedian $200 · 10th–90th $123–$3390%20%40%10th90th$200$0.5$5.0$50.0$500.0$5.0K$50.0K$500.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$120.23 / $181.97 / $331.13
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$120.23 / $169.82 / $281.84
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$239.88 / $316.23 / $794.33
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$213.80 / $245.47 / $416.87
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$275.42 / $275.42 / $1,047.13
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$204.17 / $204.17 / $371.54
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$144.54 / $204.17 / $416.87
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$138.04 / $204.17 / $316.23

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