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North Dakota 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 $309 · 10th–90th $204–$4680%20%40%10th90th$309Professionalmedian $234 · 10th–90th $145–$3160%20%10th90th$234$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. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$208.93 / $309.03 / $309.03
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$138.04 / $208.93 / $309.03
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$213.80 / $281.84 / $309.03
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
$275.42 / $295.12 / $371.54
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$93.33 / $309.03 / $912.01
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$169.82 / $208.93 / $338.84
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$186.21 / $186.21 / $501.19
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$154.88 / $263.03 / $338.84