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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.

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

$200

Typical negotiated rate. In Indiana, July 2026.

Insurers have agreed to pay about $200 for this service. The price depends on where it is billed: about $191 from a physician practice, and about $229 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 5 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$191$135 to $269
FacilityA hospital or hospital-owned outpatient department$229$204 to $269

How much rates vary

Facilitymedian $229 · 10th to 90th $135 to $363Professionalmedian $191 · 10th to 90th $123 to $331
$100$200$500facility $229professional $191

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
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

Where Indiana 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.

Indiana· 29th of 51

$200

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.