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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.

Facilitymedian $219 · 10th–90th $145$2750%10%20%10th90th$219Professionalmedian $158 · 10th–90th $115$2820%20%10th90th$158$50.0$100.0$200.0$500.0$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
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