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Vermont 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 $275 · 10th–90th $186$2750%50%10th$275Professionalmedian $200 · 10th–90th $174$2570%20%10th90th$200$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. Small sample — interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Professional
Modifier
Global
Typical Low
$173.78
Median
$199.53
Typical High
$239.88
Cigna
Setting
Facility
Modifier
Global
Typical Low
$275.42
Median
$275.42
Typical High
$275.42
Cigna
Setting
Professional
Modifier
Global
Typical Low
$204.17
Median
$204.17
Typical High
$275.42
MVP Health Care
Setting
Professional
Modifier
Global
Typical Low
$257.04
Median
$316.23
Typical High
$316.23
United
Setting
Facility
Modifier
Global
Typical Low
$186.21
Median
$186.21
Typical High
$234.42
United
Setting
Professional
Modifier
Global
Typical Low
$147.91
Median
$309.03
Typical High
$602.56