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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 July 2026.

How much does TLSO, Flexible, Sacrococcygeal to T-9, Off-the-Shelf cost?

$398

Typical negotiated rate. In Hawaii, July 2026.

Insurers have agreed to pay about $398 for this service. Most negotiated rates run $191 to $398.

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 $234 · 10th to 90th $186 to $324Professionalmedian $398 · 10th to 90th $141 to $417
$200$500facility $234professional $398

Distribution of negotiated rates across all payers (price axis is log-scale). Each curve is scaled to its own total: facility and professional rates are different services, shown together to compare where they cluster. 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
Global
Typical Low
$141.25
Median
$141.25
Typical High
$144.54
Cigna
Setting
Facility
Modifier
Global
Typical Low
$275.42
Median
$275.42
Typical High
$323.59
Cigna
Setting
Professional
Modifier
Global
Typical Low
$275.42
Median
$363.08
Typical High
$489.78
HMSA
Setting
Professional
Modifier
Global
Typical Low
$398.11
Median
$398.11
Typical High
$416.87
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$275.42
Median
$398.11
Typical High
$549.54
United
Setting
Facility
Modifier
Global
Typical Low
$186.21
Median
$190.55
Typical High
$234.42
United
Setting
Professional
Modifier
Global
Typical Low
$67.61
Median
$309.03
Typical High
$512.86

Where Hawaii sits

The same service costs 3.6 times more in Kansas than in Washington, DC. 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· 2nd of 51

$398

KS $417DC $115

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.