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

Hawaii 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?

$417

Typical negotiated rate. In Hawaii, October 2026.

Insurers have agreed to pay about $417 for this service. Most negotiated rates run $398 to $427.

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 6 insurance carriers under federal price transparency rules.

How much rates vary

Facilitymedian $324 · 10th to 90th $275 to $324Professionalmedian $417 · 10th to 90th $380 to $427
$200$500facility $324professional $417

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
Professional
Modifier
None
Typical Low
$144.54
Median
$144.54
Typical High
$144.54
Cigna
Setting
Facility
Modifier
None
Typical Low
$275.42
Median
$323.59
Typical High
$323.59
Cigna
Setting
Professional
Modifier
None
Typical Low
$426.58
Median
$426.58
Typical High
$426.58
HMSA
Setting
Professional
Modifier
None
Typical Low
$398.11
Median
$398.11
Typical High
$416.87
Kaiser Permanente
Setting
Professional
Modifier
None
Typical Low
$275.42
Median
$398.11
Typical High
$512.86
United
Setting
Professional
Modifier
None
Typical Low
$323.59
Median
$426.58
Typical High
$426.58
University Health Alliance
Setting
Professional
Modifier
None
Typical Low
$331.13
Median
$338.84
Typical High
$371.54

Where Hawaii 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.

Hawaii· 1st of 51

$417

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.