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Ohio 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 $182–$4170%20%40%10th90th$240Professionalmedian $195 · 10th–90th $120–$3090%20%10th90th$195$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
$117.49 / $234.42 / $281.84
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$117.49 / $158.49 / $234.42
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$229.09 / $239.88 / $489.78
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$194.98 / $245.47 / $398.11
CareSource
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$131.83 / $223.87 / $316.23
CareSource
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$169.82 / $234.42 / $354.81
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$275.42 / $275.42 / $295.12
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$204.17 / $204.17 / $275.42
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$275.42 / $275.42 / $275.42
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$204.17 / $204.17 / $275.42
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$147.91 / $208.93 / $295.12
SummaCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$416.87 / $416.87 / $416.87
SummaCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$331.13 / $426.58 / $812.83
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$144.54 / $190.55 / $416.87
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$123.03 / $194.98 / $295.12