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New Mexico 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 $83–$3550%10%10th90th$191Professionalmedian $151 · 10th–90th $98–$2880%20%10th90th$151$50.0$100.0$200.0$500.0

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
Facility
Modifier
Typical Low / Median / Typical High
$151.36 / $151.36 / $151.36
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$97.72 / $138.04 / $234.42
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$147.91 / $194.98 / $281.84
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 / $316.23
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$199.53 / $245.47 / $436.52
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$83.18 / $144.54 / $269.15
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$173.78 / $204.17 / $275.42
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$173.78 / $204.17 / $416.87
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$173.78 / $186.21 / $295.12