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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 July 2026.

Facilitymedian $115 · 10th–90th $115$5010%50%90th$115Professionalmedian $115 · 10th–90th $115$2140%50%90th$115$100.0$200.0$500.0

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Small sample; interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$114.82
Median
$114.82
Typical High
$114.82
Aetna
Setting
Professional
Modifier
Global
Typical Low
$114.82
Median
$114.82
Typical High
$199.53
CareFirst
Setting
Professional
Modifier
Global
Typical Low
$223.87
Median
$257.04
Typical High
$257.04
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
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$154.88
Median
$199.53
Typical High
$588.84
United
Setting
Facility
Modifier
Global
Typical Low
$501.19
Median
$501.19
Typical High
$501.19
United
Setting
Professional
Modifier
Global
Typical Low
$134.90
Median
$204.17
Typical High
$263.03