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

Indiana 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 $229 · 10th–90th $135$3630%50%10th90th$229Professionalmedian $191 · 10th–90th $123$3310%20%10th90th$191$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
$134.90
Median
$134.90
Typical High
$134.90
Aetna
Setting
Professional
Modifier
Global
Typical Low
$120.23
Median
$141.25
Typical High
$213.80
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$204.17
Median
$229.09
Typical High
$457.09
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$239.88
Median
$269.15
Typical High
$426.58
CareSource
Setting
Facility
Modifier
Global
Typical Low
$263.03
Median
$338.84
Typical High
$389.05
Cigna
Setting
Facility
Modifier
Global
Typical Low
$229.09
Median
$275.42
Typical High
$363.08
Cigna
Setting
Professional
Modifier
Global
Typical Low
$204.17
Median
$204.17
Typical High
$316.23
United
Setting
Facility
Modifier
Global
Typical Low
$144.54
Median
$186.21
Typical High
$281.84
United
Setting
Professional
Modifier
Global
Typical Low
$123.03
Median
$208.93
Typical High
$309.03