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

Florida 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 $229 · 10th–90th $178$6460%20%10th90th$229Professionalmedian $200 · 10th–90th $145$2820%20%10th90th$200$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
$177.83
Median
$204.17
Typical High
$229.09
Aetna
Setting
Professional
Modifier
Global
Typical Low
$141.25
Median
$199.53
Typical High
$281.84
AvMed
Setting
Facility
Modifier
Global
Typical Low
$269.15
Median
$269.15
Typical High
$269.15
AvMed
Setting
Professional
Modifier
Global
Typical Low
$213.80
Median
$269.15
Typical High
$288.40
Cigna
Setting
Facility
Modifier
Global
Typical Low
$275.42
Median
$275.42
Typical High
$363.08
Cigna
Setting
Professional
Modifier
Global
Typical Low
$204.17
Median
$204.17
Typical High
$275.42
Florida Blue
Setting
Facility
Modifier
Global
Typical Low
$645.65
Median
$645.65
Typical High
$645.65
Florida Blue
Setting
Professional
Modifier
Global
Typical Low
$97.72
Median
$162.18
Typical High
$331.13
Molina
Setting
Professional
Modifier
Global
Typical Low
$151.36
Median
$186.21
Typical High
$208.93
United
Setting
Facility
Modifier
Global
Typical Low
$147.91
Median
$204.17
Typical High
$295.12
United
Setting
Professional
Modifier
Global
Typical Low
$141.25
Median
$208.93
Typical High
$295.12
Wellpoint
Setting
Professional
Modifier
Global
Typical Low
$186.21
Median
$186.21
Typical High
$269.15