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

Washington, DC 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 Washington, DC, October 2026.

Insurers have agreed to pay about $204 for this service. Most negotiated rates run $162 to $257.

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.

How much rates vary

Facilitymedian $115 · 10th to 90th $115 to $295Professionalmedian $204 · 10th to 90th $115 to $257
$200$500facility $115professional $204

Distribution of negotiated rates across all payers (price axis is log-scale). Small sample; interpret with caution. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
None
Typical Low
$114.82
Median
$114.82
Typical High
$114.82
Aetna
Setting
Professional
Modifier
None
Typical Low
$114.82
Median
$114.82
Typical High
$199.53
Aetna
Setting
Professional
Modifier
52 · Reduced service
Typical Low
$57.54
Median
$57.54
Typical High
$100.00
Aetna
Setting
Professional
Modifier
53 · Discontinued
Typical Low
$22.91
Median
$22.91
Typical High
$40.74
Aetna
Setting
Professional
Modifier
55 · Aftercare only
Typical Low
$16.98
Median
$16.98
Typical High
$30.20
Aetna
Setting
Professional
Modifier
56 · Pre-op care only
Typical Low
$11.48
Median
$11.48
Typical High
$19.95
CareFirst
Setting
Professional
Modifier
None
Typical Low
$223.87
Median
$257.04
Typical High
$257.04
Cigna
Setting
Facility
Modifier
None
Typical Low
$275.42
Median
$275.42
Typical High
$295.12
Cigna
Setting
Professional
Modifier
None
Typical Low
$204.17
Median
$204.17
Typical High
$275.42
Kaiser Permanente
Setting
Professional
Modifier
None
Typical Low
$154.88
Median
$199.53
Typical High
$588.84
United
Setting
Professional
Modifier
None
Typical Low
$134.90
Median
$204.17
Typical High
$251.19

Where Washington, DC 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.

Washington, DC· 41st of 51

$204

HI $417UT $162

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.