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California 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 $339 · 10th–90th $269–$8510%20%10th90th$339Professionalmedian $204 · 10th–90th $135–$5010%20%10th90th$204$0.5$2.0$10.0$50.0$200.0$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
Facility
Modifier
Typical Low / Median / Typical High
$234.42 / $234.42 / $501.19
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$134.90 / $199.53 / $501.19
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$269.15 / $338.84 / $851.14
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$194.98 / $239.88 / $346.74
Blue Shield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$245.47 / $616.60 / $954.99
Blue Shield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$186.21 / $363.08 / $501.19
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 / $275.42
Contra Costa Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$117.49 / $257.04 / $309.03
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$83.18 / $309.03 / $549.54
Lucent Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,174.90 / $1,174.90 / $1,174.90
Lucent Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,737.80 / $1,737.80 / $1,737.80
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$245.47 / $245.47 / $245.47
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$83.18 / $141.25 / $338.84
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$123.03 / $204.17 / $275.42
Sutter Health Plus
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$776.25 / $776.25 / $776.25
The Alliance
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$95.50 / $263.03 / $436.52
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$30.90 / $186.21 / $416.87
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$117.49 / $199.53 / $346.74