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

Idaho 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?

$204

Typical negotiated rate. In Idaho, July 2026.

Insurers have agreed to pay about $204 for this service. The price depends on where it is billed: about $204 from a physician practice, and about $214 from a hospital or other facility. The two figures are alternatives, not parts of one bill.

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 8 insurance carriers under federal price transparency rules.

Where it's billed changes the price

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$204$138 to $275
FacilityA hospital or hospital-owned outpatient department$214$166 to $288

How much rates vary

Facilitymedian $214 · 10th to 90th $117 to $380Professionalmedian $204 · 10th to 90th $115 to $380
$100$200$500facility $214professional $204

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. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Professional
Modifier
Global
Typical Low
$114.82
Median
$162.18
Typical High
$234.42
BCBS
Setting
Facility
Modifier
Global
Typical Low
$165.96
Median
$331.13
Typical High
$426.58
BCBS
Setting
Professional
Modifier
Global
Typical Low
$354.81
Median
$380.19
Typical High
$380.19
Cigna
Setting
Facility
Modifier
Global
Typical Low
$275.42
Median
$275.42
Typical High
$295.12
Cigna
Setting
Professional
Modifier
Global
Typical Low
$204.17
Median
$204.17
Typical High
$275.42
Moda Health
Setting
Facility
Modifier
Global
Typical Low
$83.18
Median
$199.53
Typical High
$354.81
Moda Health
Setting
Professional
Modifier
Global
Typical Low
$107.15
Median
$169.82
Typical High
$208.93
Molina
Setting
Professional
Modifier
Global
Typical Low
$30.20
Median
$30.20
Typical High
$288.40
Regence BlueShield
Setting
Facility
Modifier
Global
Typical Low
$165.96
Median
$165.96
Typical High
$251.19
Regence BlueShield
Setting
Professional
Modifier
Global
Typical Low
$123.03
Median
$123.03
Typical High
$239.88
Select Health
Setting
Facility
Modifier
Global
Typical Low
$177.83
Median
$177.83
Typical High
$457.09
Select Health
Setting
Professional
Modifier
Global
Typical Low
$177.83
Median
$229.09
Typical High
$338.84
United
Setting
Facility
Modifier
Global
Typical Low
$0.30
Median
$204.17
Typical High
$234.42
United
Setting
Professional
Modifier
Global
Typical Low
$173.78
Median
$186.21
Typical High
$234.42

Where Idaho 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.

Idaho· 27th of 51

$204

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.