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

Illinois 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 $186 · 10th–90th $141$9330%20%10th90th$186Professionalmedian $170 · 10th–90th $141$3160%20%10th90th$170$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
$141.25
Median
$141.25
Typical High
$229.09
Aetna
Setting
Professional
Modifier
Global
Typical Low
$141.25
Median
$144.54
Typical High
$229.09
BCBS
Setting
Facility
Modifier
Global
Typical Low
$275.42
Median
$371.54
Typical High
$2,691.53
BCBS
Setting
Professional
Modifier
Global
Typical Low
$147.91
Median
$173.78
Typical High
$173.78
Cigna
Setting
Facility
Modifier
Global
Typical Low
$275.42
Median
$275.42
Typical High
$380.19
Cigna
Setting
Professional
Modifier
Global
Typical Low
$204.17
Median
$204.17
Typical High
$295.12
Hally Health
Setting
Professional
Modifier
Global
Typical Low
$223.87
Median
$389.05
Typical High
$512.86
Hally Health
Setting
Facility
Modifier
Global
Typical Low
$100.00
Median
$100.00
Typical High
$100.00
Hally Health
Setting
Professional
Modifier
Global
Typical Low
$288.40
Median
$288.40
Typical High
$288.40
Molina
Setting
Professional
Modifier
Global
Typical Low
$177.83
Median
$177.83
Typical High
$257.04
United
Setting
Facility
Modifier
Global
Typical Low
$181.97
Median
$186.21
Typical High
$309.03
United
Setting
Professional
Modifier
Global
Typical Low
$144.54
Median
$208.93
Typical High
$323.59