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

California 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 $339 · 10th–90th $269$8510%20%10th90th$339Professionalmedian $234 · 10th–90th $120$5010%20%10th90th$234$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
Facility
Modifier
Global
Typical Low
$234.42
Median
$234.42
Typical High
$501.19
Aetna
Setting
Professional
Modifier
Global
Typical Low
$120.23
Median
$229.09
Typical High
$501.19
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$269.15
Median
$338.84
Typical High
$851.14
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$194.98
Median
$239.88
Typical High
$331.13
Blue Shield
Setting
Facility
Modifier
Global
Typical Low
$208.93
Median
$660.69
Typical High
$1,000.00
Blue Shield
Setting
Professional
Modifier
Global
Typical Low
$100.00
Median
$218.78
Typical High
$457.09
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
Contra Costa Health
Setting
Professional
Modifier
Global
Typical Low
$117.49
Median
$257.04
Typical High
$309.03
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$83.18
Median
$309.03
Typical High
$549.54
Lucent Health
Setting
Facility
Modifier
Global
Typical Low
$1,174.90
Median
$1,174.90
Typical High
$1,174.90
Lucent Health
Setting
Professional
Modifier
Global
Typical Low
$1,737.80
Median
$1,737.80
Typical High
$1,737.80
Molina
Setting
Professional
Modifier
Global
Typical Low
$245.47
Median
$245.47
Typical High
$245.47
Providence
Setting
Facility
Modifier
Global
Typical Low
$83.18
Median
$141.25
Typical High
$338.84
Providence
Setting
Professional
Modifier
Global
Typical Low
$123.03
Median
$204.17
Typical High
$275.42
Sutter Health Plus
Setting
Professional
Modifier
Global
Typical Low
$776.25
Median
$776.25
Typical High
$776.25
The Alliance
Setting
Professional
Modifier
Global
Typical Low
$95.50
Median
$263.03
Typical High
$436.52
United
Setting
Facility
Modifier
Global
Typical Low
$30.90
Median
$186.21
Typical High
$416.87
United
Setting
Professional
Modifier
Global
Typical Low
$117.49
Median
$199.53
Typical High
$338.84