go back

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

Georgia 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 $269 · 10th–90th $158$1,0000%20%10th90th$269Professionalmedian $229 · 10th–90th $141$3800%10%20%10th90th$229$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
$158.49
Median
$158.49
Typical High
$416.87
Aetna
Setting
Professional
Modifier
Global
Typical Low
$138.04
Median
$158.49
Typical High
$281.84
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$269.15
Median
$645.65
Typical High
$1,000.00
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$239.88
Median
$346.74
Typical High
$457.09
CareSource
Setting
Facility
Modifier
Global
Typical Low
$263.03
Median
$263.03
Typical High
$263.03
CareSource
Setting
Professional
Modifier
Global
Typical Low
$223.87
Median
$223.87
Typical High
$223.87
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
$354.81
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$204.17
Median
$269.15
Typical High
$575.44
United
Setting
Facility
Modifier
Global
Typical Low
$131.83
Median
$186.21
Typical High
$269.15
United
Setting
Professional
Modifier
Global
Typical Low
$141.25
Median
$208.93
Typical High
$331.13