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

Alaska 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 $83 · 10th–90th $83$3800%50%90th$83Professionalmedian $234 · 10th–90th $112$4370%10%10th90th$234$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. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Professional
Modifier
Global
Typical Low
$95.50
Median
$177.83
Typical High
$338.84
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
$426.58
Moda Health
Setting
Facility
Modifier
Global
Typical Low
$83.18
Median
$117.49
Typical High
$380.19
Moda Health
Setting
Professional
Modifier
Global
Typical Low
$112.20
Median
$380.19
Typical High
$588.84
Premera BCBS
Setting
Facility
Modifier
Global
Typical Low
$173.78
Median
$380.19
Typical High
$398.11
Premera BCBS
Setting
Professional
Modifier
Global
Typical Low
$323.59
Median
$380.19
Typical High
$398.11
Providence
Setting
Facility
Modifier
Global
Typical Low
$83.18
Median
$83.18
Typical High
$371.54
Providence
Setting
Professional
Modifier
Global
Typical Low
$60.26
Median
$275.42
Typical High
$302.00
United
Setting
Facility
Modifier
Global
Typical Low
$186.21
Median
$199.53
Typical High
$234.42
United
Setting
Professional
Modifier
Global
Typical Low
$194.98
Median
$309.03
Typical High
$512.86