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

Massachusetts 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 $288 · 10th–90th $178$1,4790%20%10th90th$288Professionalmedian $229 · 10th–90th $158$3390%20%40%10th90th$229$0.5$5.0$50.0$500.0$5.0K$50.0K

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
$177.83
Median
$177.83
Typical High
$177.83
Aetna
Setting
Professional
Modifier
Global
Typical Low
$144.54
Median
$177.83
Typical High
$281.84
AllWays Health Partners
Setting
Facility
Modifier
Global
Typical Low
$257.04
Median
$288.40
Typical High
$1,174.90
AllWays Health Partners
Setting
Professional
Modifier
Global
Typical Low
$144.54
Median
$257.04
Typical High
$371.54
BCBS
Setting
Facility
Modifier
Global
Typical Low
$489.78
Median
$489.78
Typical High
$1,479.11
Cigna
Setting
Facility
Modifier
Global
Typical Low
$275.42
Median
$275.42
Typical High
$275.42
Cigna
Setting
Professional
Modifier
Global
Typical Low
$204.17
Median
$204.17
Typical High
$288.40
Fallon Health
Setting
Facility
Modifier
Global
Typical Low
$60.26
Median
$3,630.78
Typical High
$9,772.37
Harvard Pilgrim
Setting
Professional
Modifier
Global
Typical Low
$229.09
Median
$229.09
Typical High
$346.74
Health New England
Setting
Professional
Modifier
Global
Typical Low
$190.55
Median
$190.55
Typical High
$190.55
Mass General Brigham
Setting
Facility
Modifier
Global
Typical Low
$257.04
Median
$288.40
Typical High
$1,174.90
Mass General Brigham
Setting
Professional
Modifier
Global
Typical Low
$144.54
Median
$257.04
Typical High
$371.54
United
Setting
Facility
Modifier
Global
Typical Low
$144.54
Median
$234.42
Typical High
$416.87
United
Setting
Professional
Modifier
Global
Typical Low
$154.88
Median
$229.09
Typical High
$316.23