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Alaska 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 $83 · 10th–90th $83–$3800%50%90th$83Professionalmedian $209 · 10th–90th $120–$3800%10%10th90th$209$100.0$200.0$500.0$1.0K

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
Professional
Modifier
Typical Low / Median / Typical High
$120.23 / $204.17 / $281.84
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$275.42 / $275.42 / $275.42
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$204.17 / $204.17 / $426.58
Moda Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$83.18 / $117.49 / $380.19
Moda Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$112.20 / $380.19 / $588.84
Premera BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$173.78 / $380.19 / $398.11
Premera BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$323.59 / $380.19 / $398.11
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$83.18 / $83.18 / $371.54
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$60.26 / $275.42 / $302.00
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$186.21 / $186.21 / $199.53
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$194.98 / $309.03 / $512.86