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

Kentucky 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 $200 · 10th–90th $158$3630%20%40%10th90th$200Professionalmedian $204 · 10th–90th $120$3310%20%10th90th$204$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
$158.49
Median
$158.49
Typical High
$162.18
Aetna
Setting
Professional
Modifier
Global
Typical Low
$120.23
Median
$158.49
Typical High
$229.09
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$239.88
Median
$269.15
Typical High
$281.84
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$239.88
Median
$331.13
Typical High
$331.13
CareSource
Setting
Facility
Modifier
Global
Typical Low
$194.98
Median
$354.81
Typical High
$457.09
CareSource
Setting
Professional
Modifier
Global
Typical Low
$263.03
Median
$331.13
Typical High
$416.87
Cigna
Setting
Facility
Modifier
Global
Typical Low
$275.42
Median
$363.08
Typical High
$363.08
Cigna
Setting
Professional
Modifier
Global
Typical Low
$204.17
Median
$331.13
Typical High
$1,202.26
Molina
Setting
Professional
Modifier
Global
Typical Low
$269.15
Median
$346.74
Typical High
$446.68
United
Setting
Facility
Modifier
Global
Typical Low
$131.83
Median
$186.21
Typical High
$234.42
United
Setting
Professional
Modifier
Global
Typical Low
$123.03
Median
$199.53
Typical High
$295.12