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

Colorado 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 $166 · 10th–90th $83$3550%20%10th90th$166Professionalmedian $166 · 10th–90th $95$2750%10%20%10th90th$166$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
$95.50
Median
$95.50
Typical High
$165.96
Aetna
Setting
Professional
Modifier
Global
Typical Low
$95.50
Median
$138.04
Typical High
$229.09
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$177.83
Median
$213.80
Typical High
$380.19
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$223.87
Median
$239.88
Typical High
$331.13
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
$288.40
Denver HMP
Setting
Facility
Modifier
Global
Typical Low
$83.18
Median
$165.96
Typical High
$426.58
Denver HMP
Setting
Professional
Modifier
Global
Typical Low
$83.18
Median
$83.18
Typical High
$83.18
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$107.15
Median
$177.83
Typical High
$630.96
Select Health
Setting
Facility
Modifier
Global
Typical Low
$186.21
Median
$323.59
Typical High
$371.54
Select Health
Setting
Professional
Modifier
Global
Typical Low
$123.03
Median
$218.78
Typical High
$346.74
United
Setting
Facility
Modifier
Global
Typical Low
$141.25
Median
$186.21
Typical High
$234.42
United
Setting
Professional
Modifier
Global
Typical Low
$138.04
Median
$186.21
Typical High
$295.12