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 October 2026.
How much does TLSO, Flexible, Sacrococcygeal to T-9, Off-the-Shelf cost?
$204
Typical negotiated rate. In Arizona, October 2026.
Insurers have agreed to pay about $204 for this service. The price depends on where it is billed: about $204 from a physician practice, and about $372 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 5 insurance carriers under federal price transparency rules.
Prices by location type
Billed by
Who charges it
Typical
Range
Physician practiceA doctor's office, clinic or independent provider
A doctor's office, clinic or independent provider
$204
$174 to $302
FacilityA hospital or hospital-owned outpatient department
A hospital or hospital-owned outpatient department
$372
$209 to $589
How much rates vary
Facilitymedian $372 · 10th to 90th $95 to $1,148Professionalmedian $204 · 10th to 90th $100 to $1,738
Distribution of negotiated rates across all payers (price axis is log-scale). Need provider-level prices or 24+ months of history? Contact us.
Rates by insurance carrier
Insurance Carrier
Facility/Professional
Modifier
Typical LowTypical Low is the 10th percentile of the published rates, Median the 50th, and Typical High the 90th. One in ten rates falls below Typical Low, and one in ten falls above Typical High.
MedianTypical Low is the 10th percentile of the published rates, Median the 50th, and Typical High the 90th. One in ten rates falls below Typical Low, and one in ten falls above Typical High.
Typical HighTypical Low is the 10th percentile of the published rates, Median the 50th, and Typical High the 90th. One in ten rates falls below Typical Low, and one in ten falls above Typical High.
Aetna
Setting
Professional
Modifier
None
Typical Low
$100.00
Median
$100.00
Typical High
$100.00
Professional
None
$100.00
$100.00
$100.00
BCBS Arizona
Setting
Facility
Modifier
None
Typical Low
$91.20
Median
$407.38
Typical High
$616.60
Facility
None
$91.20
$407.38
$616.60
BCBS Arizona
Setting
Professional
Modifier
None
Typical Low
$263.03
Median
$302.00
Typical High
$549.54
Professional
None
$263.03
$302.00
$549.54
Cigna
Setting
Facility
Modifier
None
Typical Low
$275.42
Median
$275.42
Typical High
$275.42
Facility
None
$275.42
$275.42
$275.42
Cigna
Setting
Professional
Modifier
None
Typical Low
$204.17
Median
$204.17
Typical High
$275.42
Professional
None
$204.17
$204.17
$275.42
Medica
Setting
Facility
Modifier
None
Typical Low
$100.00
Median
$501.19
Typical High
$1,148.15
Facility
None
$100.00
$501.19
$1,148.15
Medica
Setting
Professional
Modifier
None
Typical Low
$173.78
Median
$204.17
Typical High
$1,737.80
Professional
None
$173.78
$204.17
$1,737.80
United
Setting
Professional
Modifier
None
Typical Low
$125.89
Median
$186.21
Typical High
$295.12
Professional
None
$125.89
$186.21
$295.12
4 more rates with less common billing modifiers
A modifier changes what was billed, for example a reduced or repeated service. Each of these modifiers carries under 10% of the published rates for this code. Modifier combinations, and modifiers with fewer than 30 rates for a carrier, are not listed.
Insurance Carrier
Facility/Professional
Modifier
Typical LowTypical Low is the 10th percentile of the published rates, Median the 50th, and Typical High the 90th. One in ten rates falls below Typical Low, and one in ten falls above Typical High.
MedianTypical Low is the 10th percentile of the published rates, Median the 50th, and Typical High the 90th. One in ten rates falls below Typical Low, and one in ten falls above Typical High.
Typical HighTypical Low is the 10th percentile of the published rates, Median the 50th, and Typical High the 90th. One in ten rates falls below Typical Low, and one in ten falls above Typical High.
Aetna
Setting
Professional
Modifier
52 · Reduced service
Typical Low
$48.98
Median
$48.98
Typical High
$48.98
Professional
52 · Reduced service
$48.98
$48.98
$48.98
Aetna
Setting
Professional
Modifier
53 · Discontinued
Typical Low
$19.95
Median
$19.95
Typical High
$19.95
Professional
53 · Discontinued
$19.95
$19.95
$19.95
Aetna
Setting
Professional
Modifier
55 · Aftercare only
Typical Low
$14.79
Median
$14.79
Typical High
$14.79
Professional
55 · Aftercare only
$14.79
$14.79
$14.79
Aetna
Setting
Professional
Modifier
56 · Pre-op care only
Typical Low
$10.00
Median
$10.00
Typical High
$10.00
Professional
56 · Pre-op care only
$10.00
$10.00
$10.00
Where Arizona 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.