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Oklahoma 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 $162 · 10th–90th $141–$4370%20%40%10th90th$162Professionalmedian $170 · 10th–90th $123–$2690%10%20%10th90th$170$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
$144.54 / $144.54 / $144.54
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$120.23 / $151.36 / $234.42
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$251.19 / $269.15 / $269.15
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 / $295.12
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$134.90 / $181.97 / $1,000.00
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$123.03 / $199.53 / $398.11
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$186.21 / $218.78 / $354.81
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$123.03 / $186.21 / $295.12