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Kentucky 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 $158–$3890%20%10th90th$219Professionalmedian $182 · 10th–90th $123–$3310%10%10th90th$182$100.0$200.0$500.0$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 / $162.18
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$117.49 / $158.49 / $229.09
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$239.88 / $269.15 / $281.84
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$239.88 / $331.13 / $331.13
CareSource
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$194.98 / $354.81 / $457.09
CareSource
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$263.03 / $331.13 / $416.87
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$275.42 / $389.05 / $389.05
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$204.17 / $331.13 / $1,174.90
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$269.15 / $346.74 / $446.68
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$144.54 / $186.21 / $234.42
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$123.03 / $199.53 / $295.12