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Massachusetts 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 $257 · 10th–90th $178–$1,1750%20%10th90th$257Professionalmedian $229 · 10th–90th $135–$2880%20%40%10th90th$229$0.5$5.0$50.0$500.0$5.0K$50.0K

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
$177.83 / $177.83 / $177.83
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$120.23 / $177.83 / $281.84
AllWays Health Partners
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$257.04 / $288.40 / $1,174.90
AllWays Health Partners
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$144.54 / $257.04 / $354.81
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$489.78 / $489.78 / $1,479.11
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$275.42 / $275.42 / $275.42
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$204.17 / $204.17 / $288.40
Fallon Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$60.26 / $3,630.78 / $9,772.37
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$229.09 / $229.09 / $346.74
Health New England
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$190.55 / $190.55 / $190.55
Mass General Brigham
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$257.04 / $288.40 / $1,174.90
Mass General Brigham
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$144.54 / $257.04 / $354.81
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$117.49 / $223.87 / $416.87
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$144.54 / $229.09 / $316.23