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Oregon 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 $115 · 10th–90th $115–$3390%50%90th$115Professionalmedian $170 · 10th–90th $112–$3090%10%10th90th$170$50.0$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
$120.23 / $120.23 / $120.23
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$120.23 / $169.82 / $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 / $204.17
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$89.13 / $257.04 / $309.03
Moda Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$117.49 / $309.03 / $309.03
Moda Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$112.20 / $169.82 / $323.59
Pacific Source
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$114.82 / $114.82 / $323.59
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$117.49 / $138.04 / $354.81
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$79.43 / $181.97 / $323.59
Regence BlueShield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$165.96 / $407.38 / $676.08
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$117.49 / $131.83 / $181.97
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$144.54 / $208.93 / $501.19
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$123.03 / $186.21 / $295.12