go back

Maryland 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 $191 · 10th–90th $132–$2750%10%10th90th$191Professionalmedian $178 · 10th–90th $112–$2820%10%20%10th90th$178$50.0$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. Small sample — interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$112.20 / $158.49 / $281.84
CareFirst
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$223.87 / $257.04 / $257.04
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 / $204.17
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$165.96 / $234.42 / $380.19
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$131.83 / $186.21 / $234.42
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$181.97 / $204.17 / $323.59
Wellpoint
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$165.96 / $223.87 / $223.87