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

Maryland 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?

$158

Typical negotiated rate. In Maryland, July 2026.

Insurers have agreed to pay about $158 for this service. Most negotiated rates run $115 to $224.

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 6 insurance carriers under federal price transparency rules.

How much rates vary

Facilitymedian $219 · 10th to 90th $145 to $275Professionalmedian $158 · 10th to 90th $115 to $282
$100$200$500facility $219professional $158

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
Professional
Modifier
Global
Typical Low
$114.82
Median
$134.90
Typical High
$251.19
CareFirst
Setting
Professional
Modifier
Global
Typical Low
$223.87
Median
$257.04
Typical High
$257.04
Cigna
Setting
Facility
Modifier
Global
Typical Low
$275.42
Median
$275.42
Typical High
$295.12
Cigna
Setting
Professional
Modifier
Global
Typical Low
$204.17
Median
$204.17
Typical High
$204.17
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$165.96
Median
$239.88
Typical High
$380.19
United
Setting
Facility
Modifier
Global
Typical Low
$131.83
Median
$190.55
Typical High
$234.42
United
Setting
Professional
Modifier
Global
Typical Low
$173.78
Median
$208.93
Typical High
$323.59
Wellpoint
Setting
Professional
Modifier
Global
Typical Low
$165.96
Median
$223.87
Typical High
$223.87

Where Maryland 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.

Maryland· 48th of 51

$158

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.