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

Arizona 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.

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

$186

Typical negotiated rate. In Arizona, July 2026.

Insurers have agreed to pay about $186 for this service. The price depends on where it is billed: about $186 from a physician practice, and about $245 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$186$145 to $234
FacilityA hospital or hospital-owned outpatient department$245$110 to $437

How much rates vary

Facilitymedian $245 · 10th to 90th $83 to $708Professionalmedian $186 · 10th to 90th $95 to $339
$1.0$10.0$100.0$1.0Kfacility $245professional $186

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
$95.50
Median
$169.82
Typical High
$234.42
BCBS
Setting
Facility
Modifier
Global
Typical Low
$95.50
Median
$389.05
Typical High
$741.31
BCBS
Setting
Professional
Modifier
Global
Typical Low
$263.03
Median
$354.81
Typical High
$724.44
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
$275.42
Medica
Setting
Facility
Modifier
Global
Typical Low
$83.18
Median
$141.25
Typical High
$776.25
Medica
Setting
Professional
Modifier
Global
Typical Low
$134.90
Median
$186.21
Typical High
$1,737.80
United
Setting
Facility
Modifier
Global
Typical Low
$144.54
Median
$204.17
Typical High
$251.19
United
Setting
Professional
Modifier
Global
Typical Low
$95.50
Median
$186.21
Typical High
$295.12

Where Arizona sits

The same service costs 3.6 times more in Kansas than in Washington, DC. Every bar is a state, most expensive first. Pick one to see its carriers and full range.

Arizona $186 · 34th of 51
KS $417DC $115

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.