go back

Indiana 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 $229 · 10th–90th $135–$3550%20%40%10th90th$229Professionalmedian $166 · 10th–90th $123–$3090%20%10th90th$166$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
$134.90 / $134.90 / $134.90
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$117.49 / $147.91 / $245.47
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$204.17 / $229.09 / $457.09
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$239.88 / $269.15 / $436.52
CareSource
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$263.03 / $338.84 / $389.05
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$229.09 / $275.42 / $275.42
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$204.17 / $204.17 / $354.81
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$144.54 / $186.21 / $281.84
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$123.03 / $208.93 / $309.03