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Hawaii 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 $275 · 10th–90th $186–$3240%20%10th90th$275Professionalmedian $182 · 10th–90th $141–$4170%20%10th90th$182$50.0$100.0$200.0$500.0

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$138.04 / $177.83 / $208.93
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$275.42 / $275.42 / $323.59
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$275.42 / $363.08 / $489.78
HMSA
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$398.11 / $398.11 / $416.87
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$275.42 / $398.11 / $457.09
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$186.21 / $190.55 / $234.42
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$67.61 / $309.03 / $426.58