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New York 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 $240 · 10th–90th $178–$4680%20%10th90th$240Professionalmedian $234 · 10th–90th $135–$4270%20%10th90th$234$0.5$5.0$50.0$500.0$5.0K$50.0K

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
$144.54 / $316.23 / $331.13
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$112.20 / $177.83 / $245.47
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$234.42 / $234.42 / $467.74
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$239.88 / $239.88 / $602.56
CDPHP
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$275.42 / $295.12 / $295.12
CDPHP
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$295.12 / $295.12 / $295.12
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$275.42 / $275.42 / $53,703.18
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$204.17 / $204.17 / $371.54
Emblem Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$234.42 / $389.05 / $912.01
Emblem Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$154.88 / $239.88 / $446.68
Excellus BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$239.88 / $239.88 / $251.19
Excellus BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$239.88 / $257.04 / $275.42
MVP Health Care
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$524.81 / $50,118.72 / $75,857.76
MVP Health Care
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$186.21 / $223.87 / $331.13
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$154.88 / $218.78 / $660.69
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$134.90 / $223.87 / $398.11
Univera
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$239.88 / $257.04 / $288.40
Univera
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$239.88 / $257.04 / $275.42