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Minnesota 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 $380 · 10th–90th $251–$1,8620%20%10th90th$380Professionalmedian $324 · 10th–90th $158–$3390%20%40%10th90th$324$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
$208.93 / $208.93 / $208.93
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$120.23 / $177.83 / $251.19
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$302.00 / $338.84 / $489.78
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$269.15 / $338.84 / $338.84
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$588.84 / $954.99 / $2,290.87
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$295.12 / $338.84 / $380.19
Health Partners
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$776.25 / $954.99 / $1,862.09
Health Partners
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$295.12 / $295.12 / $407.38
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$165.96 / $257.04 / $1,148.15
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$123.03 / $186.21 / $398.11
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2.95 / $186.21 / $501.19
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$123.03 / $218.78 / $426.58