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TLSO, Flexible, Sacrococcygeal to T-9, Custom Fitted

Montana rates for HCPCS L0454

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 item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise

Rates data updated July 2026.

How much does TLSO, Flexible, Sacrococcygeal to T-9, Custom Fitted cost?

$363

Typical negotiated rate. In Montana, July 2026.

Insurers have agreed to pay about $363 for this service. The price depends on where it is billed: about $324 from a physician practice, and about $417 from a hospital or other facility. The two figures are alternatives, not parts of one bill.

These are rates insurers have negotiated with providers, not the amount a patient is billed. What you owe depends on your plan's deductible and coinsurance. Based on rates published by 5 insurance carriers under federal price transparency rules.

Where it's billed changes the price

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$324$170 to $417
FacilityA hospital or hospital-owned outpatient department$417$324 to $447

How much rates vary

Facilitymedian $417 · 10th to 90th $257 to $513Professionalmedian $324 · 10th to 90th $120 to $813
$100$200$500$1Kfacility $417professional $324

Distribution of negotiated rates across all payers (price axis is log-scale). Each curve is scaled to its own total: facility and professional rates are different services, shown together to compare where they cluster. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Professional
Modifier
Global
Typical Low
$120.23
Median
$218.78
Typical High
$1,778.28
Cigna
Setting
Facility
Modifier
Global
Typical Low
$234.42
Median
$446.68
Typical High
$446.68
Cigna
Setting
Professional
Modifier
Global
Typical Low
$234.42
Median
$446.68
Typical High
$446.68
MountainHealth Co-op
Setting
Facility
Modifier
Global
Typical Low
$323.59
Median
$416.87
Typical High
$812.83
MountainHealth Co-op
Setting
Professional
Modifier
Global
Typical Low
$323.59
Median
$416.87
Typical High
$812.83
Providence
Setting
Facility
Modifier
Global
Typical Low
$199.53
Median
$389.05
Typical High
$512.86
Providence
Setting
Professional
Modifier
Global
Typical Low
$79.43
Median
$331.13
Typical High
$446.68
United
Setting
Facility
Modifier
Global
Typical Low
$186.21
Median
$208.93
Typical High
$234.42
United
Setting
Professional
Modifier
Global
Typical Low
$169.82
Median
$186.21
Typical High
$281.84

Where Montana sits

The same service costs 2.5 times more in Hawaii than in Washington, DC. Every bar is a state, most expensive first. Touch or drag across it to read any state, then open that state for its carriers and full range.

Montana· 6th of 51

$363

HI $417DC $166

Median negotiated rate in each state, from every insurer that publishes one. States where no insurer publishes a rate for this service are not shown.