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Iowa 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 $309 · 10th–90th $186–$8510%10%20%10th90th$309Professionalmedian $182 · 10th–90th $135–$3310%20%10th90th$182$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
$186.21 / $186.21 / $309.03
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$120.23 / $173.78 / $288.40
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$275.42 / $275.42 / $380.19
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$275.42 / $295.12 / $380.19
Hally Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$223.87 / $398.11 / $426.58
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$199.53 / $436.52 / $1,148.15
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$190.55 / $275.42 / $691.83
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$371.54 / $398.11 / $912.01
Midlands
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$380.19 / $380.19 / $380.19
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$691.83 / $691.83 / $691.83
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$144.54 / $309.03 / $812.83
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$186.21 / $208.93 / $354.81
Wellmark
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$263.03 / $331.13 / $331.13