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New Hampshire 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 $282 · 10th–90th $240–$3160%20%10th90th$282Professionalmedian $229 · 10th–90th $178–$3090%50%10th90th$229$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
$239.88 / $239.88 / $288.40
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$151.36 / $208.93 / $288.40
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$269.15 / $288.40 / $331.13
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$239.88 / $239.88 / $239.88
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 / $275.42
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$229.09 / $229.09 / $426.58
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$117.49 / $186.21 / $218.78
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$134.90 / $229.09 / $331.13
Well Sense
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$251.19 / $251.19 / $323.59