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Idaho 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 $219 · 10th–90th $117–$3800%10%20%10th90th$219Professionalmedian $204 · 10th–90th $120–$3800%10%20%10th90th$204$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. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$120.23 / $186.21 / $234.42
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$165.96 / $331.13 / $426.58
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$354.81 / $380.19 / $380.19
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$275.42 / $275.42 / $295.12
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$204.17 / $204.17 / $275.42
Moda Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$83.18 / $199.53 / $309.03
Moda Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$107.15 / $169.82 / $208.93
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$30.20 / $30.20 / $288.40
Regence BlueShield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$165.96 / $165.96 / $251.19
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$123.03 / $123.03 / $239.88
Select Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$173.78 / $177.83 / $338.84
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$186.21 / $204.17 / $234.42
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$173.78 / $186.21 / $295.12