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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 October 2026.

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

$224

Typical negotiated rate. In Maryland, October 2026.

Insurers have agreed to pay about $224 for this service. Most negotiated rates run $204 to $257.

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 7 insurance carriers under federal price transparency rules.

How much rates vary

Facilitymedian $275 · 10th to 90th $275 to $275Professionalmedian $224 · 10th to 90th $115 to $263
$200facility $275professional $224

Distribution of negotiated rates across all payers (price axis is log-scale). Small sample; interpret with caution. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Professional
Modifier
None
Typical Low
$114.82
Median
$114.82
Typical High
$158.49
Aetna
Setting
Professional
Modifier
52 · Reduced service
Typical Low
$57.54
Median
$57.54
Typical High
$79.43
Aetna
Setting
Professional
Modifier
53 · Discontinued
Typical Low
$22.91
Median
$22.91
Typical High
$31.62
Aetna
Setting
Professional
Modifier
55 · Aftercare only
Typical Low
$16.98
Median
$16.98
Typical High
$23.99
Aetna
Setting
Professional
Modifier
56 · Pre-op care only
Typical Low
$11.48
Median
$11.48
Typical High
$15.85
CareFirst
Setting
Professional
Modifier
None
Typical Low
$223.87
Median
$257.04
Typical High
$257.04
Cigna
Setting
Facility
Modifier
None
Typical Low
$275.42
Median
$275.42
Typical High
$275.42
Cigna
Setting
Professional
Modifier
None
Typical Low
$204.17
Median
$204.17
Typical High
$275.42
Johns Hopkins Employer Health Plan
Setting
Professional
Modifier
None
Typical Low
$234.42
Median
$234.42
Typical High
$234.42
Kaiser Permanente
Setting
Professional
Modifier
None
Typical Low
$165.96
Median
$245.47
Typical High
$380.19
United
Setting
Professional
Modifier
None
Typical Low
$181.97
Median
$208.93
Typical High
$316.23
Wellpoint
Setting
Professional
Modifier
None
Typical Low
$223.87
Median
$223.87
Typical High
$223.87

Where Maryland sits

The same service costs 2.6 times more in Hawaii than in Utah. 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· 28th of 51

$224

HI $417UT $162

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.