go back

Virginia 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 $269 · 10th–90th $166–$4070%20%40%10th90th$269Professionalmedian $214 · 10th–90th $138–$3630%20%40%10th90th$214$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
$112.20 / $199.53 / $338.84
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$112.20 / $199.53 / $281.84
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$269.15 / $269.15 / $288.40
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$239.88 / $239.88 / $501.19
CareFirst
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$223.87 / $257.04 / $257.04
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$181.97 / $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
$177.83 / $275.42 / $436.52
Medcost
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$114.82 / $223.87 / $398.11
Medcost
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$223.87 / $251.19 / $338.84
Sentara
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$213.80 / $316.23 / $537.03
Sentara
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$213.80 / $316.23 / $537.03
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$131.83 / $190.55 / $416.87
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$190.55 / $204.17 / $338.84