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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.

Facilitymedian $245 · 10th–90th $83$7080%10%10th90th$245Professionalmedian $186 · 10th–90th $95$3390%20%10th90th$186$0.5$2.0$10.0$50.0$200.0$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
$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