Thoracolumbosacral orthosis, flexible back brace

Hospitals report these codes with terse, inconsistent chargemaster text. This plain-English title was written by an AI model from that text and has not been reviewed by a person, so it can be wrong. The prices on this page come straight from hospital filings and do not depend on it.

Model: claude-haiku-5-5
Provider: anthropic
API: message_batches
Reasoning effort: low
Max output tokens: 4096
Prompt version (hash): 444523875572
Generated: October 20, 2026

Original text from hospital filings

DME POS

Payers reporting HCPCS L0455

Payer pricing summary

Low

$35

Average

$325

Median

$300

High

$683

Payer rate distribution

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Filter by billing class

#
1	Aetna fee schedule · outpatient · +12 other terms	378	$259	$286	$169	59%	—	$116 – $2.2k
2	UnitedHealthcare fee schedule · outpatient · +14 other terms	364	$262	$267	$63	24%	—	$101 – $422
3	Humana fee schedule · outpatient · +10 other terms	338	$267	$463	$694	150%	—	$119 – $3.3k
4	WellCare fee schedule · outpatient · +4 other terms	224	$262	$271	$53	20%	—	$122 – $461
5	Blue Cross Blue Shield fee schedule · outpatient · +9 other terms	222	$267	$314	$218	69%	—	$0 – $2.1k
6	Devoted fee schedule · outpatient · +3 other terms	179	$267	$260	$42	16%	—	$169 – $395
7	Molina fee schedule · outpatient · +5 other terms	144	$308	$331	$141	43%	—	$116 – $914
8	Cigna Healthspring fee schedule · outpatient · +1 other terms	123	$275	$263	$34	13%	—	$177 – $377
9	Cigna fee schedule · outpatient · +10 other terms	107	$269	$299	$122	41%	—	$119 – $764
10	Anthem fee schedule · outpatient · +6 other terms	84	$262	$321	$301	94%	—	$119 – $1.7k
11	Kaiser fee schedule · outpatient · +4 other terms	64	$180	$258	$219	85%	—	$119 – $1.4k
12	Superior Healthplan fee schedule · outpatient	41	$267	$270	$17	6%	—	$247 – $366
13	Clover fee schedule · outpatient · +2 other terms	39	$267	$264	$38	14%	—	$230 – $366
14	Ambetter facility · fee schedule · outpatient · +6 other terms	36	$412	$560	$211	38%	—	$252 – $870
15	Optum fee schedule · outpatient · +2 other terms	36	$269	$325	$142	44%	—	$169 – $635
16	Oscar fee schedule · outpatient · +6 other terms	35	$249	$269	$46	17%	—	$202 – $452
17	Caresource fee schedule · outpatient · +5 other terms	29	$269	$289	$36	12%	—	$231 – $353
18	Bcbs Tx fee schedule · outpatient	23	$247	$273	$49	18%	—	$247 – $365
19	Regence facility · fee schedule · outpatient · +3 other terms	20	$184	$223	$91	41%	—	$98 – $389
20	Amerihealth Caritas fee schedule · outpatient · +1 other terms	19	$323	$322	$39	12%	—	$241 – $419
21	Medicare fee schedule · outpatient · +1 other terms	18	$169	$192	$58	30%	—	$169 – $342
22	Medical Mutual facility · fee schedule · outpatient · +1 other terms	15	$229	$272	$68	25%	—	$124 – $361
23	Bcbs Mn fee schedule · outpatient · +4 other terms	13	$338	$334	$96	29%	—	$189 – $454
24	Medica fee schedule · outpatient · +5 other terms	13	$462	$473	$145	31%	—	$268 – $654
25	Wellmark fee schedule · both · +2 other terms	13	$332	$328	$27	8%	—	$164 – $332

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