go back

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 October 2026.

How much does TLSO, Flexible, Sacrococcygeal to T-9, Off-the-Shelf cost?

$380

Typical negotiated rate. In Alaska, October 2026.

Insurers have agreed to pay about $380 for this service. The price depends on where it is billed: about $380 from a physician practice, and about $339 from a hospital or other facility.

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 6 insurance carriers under federal price transparency rules.

Prices by location type

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$380$302 to $380
FacilityA hospital or hospital-owned outpatient department$339$275 to $380

How much rates vary

Facilitymedian $339 · 10th to 90th $174 to $398Professionalmedian $380 · 10th to 90th $195 to $398
$100$200$500$1Kfacility $339professional $380

Distribution of negotiated rates across all payers (price axis is log-scale). Small sample; interpret with caution. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
None
Typical Low
$338.84
Median
$338.84
Typical High
$338.84
Aetna
Setting
Professional
Modifier
None
Typical Low
$134.90
Median
$338.84
Typical High
$338.84
Cigna
Setting
Facility
Modifier
None
Typical Low
$275.42
Median
$275.42
Typical High
$295.12
Cigna
Setting
Professional
Modifier
None
Typical Low
$204.17
Median
$204.17
Typical High
$426.58
Moda Health
Setting
Facility
Modifier
None
Typical Low
$83.18
Median
$380.19
Typical High
$478.63
Moda Health
Setting
Professional
Modifier
None
Typical Low
$112.20
Median
$380.19
Typical High
$398.11
Premera BCBS
Setting
Facility
Modifier
None
Typical Low
$173.78
Median
$173.78
Typical High
$398.11
Premera BCBS
Setting
Professional
Modifier
None
Typical Low
$338.84
Median
$380.19
Typical High
$389.05
Providence
Setting
Facility
Modifier
None
Typical Low
$83.18
Median
$275.42
Typical High
$478.63
Providence
Setting
Professional
Modifier
None
Typical Low
$60.26
Median
$275.42
Typical High
$426.58
United
Setting
Professional
Modifier
None
Typical Low
$194.98
Median
$302.00
Typical High
$512.86

Where Alaska sits

The same service costs 2.6 times more in Hawaii than in Utah. 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.

Alaska· 2nd of 51

$380

HI $417UT $162

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.