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Georgia 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 $269 · 10th–90th $158–$1,0000%20%10th90th$269Professionalmedian $209 · 10th–90th $138–$3800%10%20%10th90th$209$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
$158.49 / $158.49 / $416.87
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$134.90 / $162.18 / $281.84
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$269.15 / $645.65 / $1,000.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$229.09 / $346.74 / $457.09
CareSource
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$263.03 / $263.03 / $263.03
CareSource
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$223.87 / $223.87 / $223.87
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 / $354.81
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$204.17 / $269.15 / $575.44
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$131.83 / $186.21 / $275.42
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$141.25 / $208.93 / $331.13