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

Arkansas 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 $398,107 · 10th–90th $234$891,2510%10%20%10th90th$398,107Professionalmedian $204 · 10th–90th $155$2450%50%10th90th$204$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
$234.42
Median
$234.42
Typical High
$234.42
Aetna
Setting
Professional
Modifier
Global
Typical Low
$154.88
Median
$229.09
Typical High
$245.47
BCBS
Setting
Facility
Modifier
Global
Typical Low
$218,776.16
Median
$524,807.46
Typical High
$954,992.59
BCBS
Setting
Professional
Modifier
Global
Typical Low
$223.87
Median
$223.87
Typical High
$295.12
Cigna
Setting
Facility
Modifier
Global
Typical Low
$213.80
Median
$275.42
Typical High
$380.19
Cigna
Setting
Professional
Modifier
Global
Typical Low
$204.17
Median
$204.17
Typical High
$275.42
United
Setting
Facility
Modifier
Global
Typical Low
$144.54
Median
$199.53
Typical High
$416.87
United
Setting
Professional
Modifier
Global
Typical Low
$123.03
Median
$199.53
Typical High
$295.12