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TLSO, Flexible, Sacrococcygeal to T-9, Off-the-Shelf

Nationwide 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

Rates data updated July 2026.

Facilitymedian $288 · 10th–90th $141$7940%20%40%10th90th$288Professionalmedian $209 · 10th–90th $132$3470%20%40%10th90th$209$0.5$5.0$50.0$500.0$5.0K$50.0K$500.0K

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
Setting
Facility
Modifier
Global
Typical Low
$120.23
Median
$177.83
Typical High
$309.03
Aetna
Setting
Professional
Modifier
Global
Typical Low
$120.23
Median
$173.78
Typical High
$281.84
BCBS
Setting
Facility
Modifier
Global
Typical Low
$239.88
Median
$316.23
Typical High
$794.33
BCBS
Setting
Professional
Modifier
Global
Typical Low
$213.80
Median
$251.19
Typical High
$416.87
Cigna
Setting
Facility
Modifier
Global
Typical Low
$275.42
Median
$275.42
Typical High
$1,023.29
Cigna
Setting
Professional
Modifier
Global
Typical Low
$204.17
Median
$204.17
Typical High
$371.54
United
Setting
Facility
Modifier
Global
Typical Low
$144.54
Median
$218.78
Typical High
$416.87
United
Setting
Professional
Modifier
Global
Typical Low
$134.90
Median
$204.17
Typical High
$316.23