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Michigan 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 $339 · 10th–90th $155–$8910%10%20%10th90th$339Professionalmedian $182 · 10th–90th $120–$2820%20%10th90th$182$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
$154.88 / $154.88 / $154.88
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$120.23 / $154.88 / $239.88
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$295.12 / $676.08 / $1,288.25
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$223.87 / $223.87 / $234.42
CareSource
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$169.82 / $169.82 / $169.82
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 / $275.42 / $467.74
Health Alliance Plan
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$154.88 / $758.58 / $831.76
Health Alliance Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$154.88 / $281.84 / $380.19
Priority Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$275.42 / $275.42 / $275.42
Priority Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$204.17 / $346.74 / $416.87
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$144.54 / $218.78 / $416.87
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$138.04 / $194.98 / $323.59