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

Minnesota 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?

$339

Typical negotiated rate. In Minnesota, July 2026.

Insurers have agreed to pay about $339 for this service. The price depends on where it is billed: about $331 from a physician practice, and about $603 from a hospital or other facility. The two figures are alternatives, not parts of one bill.

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.

Where it's billed changes the price

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$331$275 to $339
FacilityA hospital or hospital-owned outpatient department$603$339 to $1,023

How much rates vary

Facilitymedian $603 · 10th to 90th $257 to $2,089Professionalmedian $331 · 10th to 90th $209 to $339
$1.0$10.0$100.0$1.0Kfacility $603professional $331

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
Facility
Modifier
Global
Typical Low
$208.93
Median
$208.93
Typical High
$208.93
Aetna
Setting
Professional
Modifier
Global
Typical Low
$120.23
Median
$208.93
Typical High
$309.03
BCBS
Setting
Facility
Modifier
Global
Typical Low
$309.03
Median
$338.84
Typical High
$512.86
BCBS
Setting
Professional
Modifier
Global
Typical Low
$269.15
Median
$338.84
Typical High
$338.84
Cigna
Setting
Facility
Modifier
Global
Typical Low
$588.84
Median
$977.24
Typical High
$2,691.53
Cigna
Setting
Professional
Modifier
Global
Typical Low
$295.12
Median
$338.84
Typical High
$380.19
Health Partners
Setting
Facility
Modifier
Global
Typical Low
$741.31
Median
$1,071.52
Typical High
$2,089.30
Health Partners
Setting
Professional
Modifier
Global
Typical Low
$295.12
Median
$295.12
Typical High
$407.38
Medica
Setting
Facility
Modifier
Global
Typical Low
$165.96
Median
$257.04
Typical High
$1,148.15
Medica
Setting
Professional
Modifier
Global
Typical Low
$123.03
Median
$186.21
Typical High
$398.11
United
Setting
Facility
Modifier
Global
Typical Low
$2.95
Median
$186.21
Typical High
$501.19
United
Setting
Professional
Modifier
Global
Typical Low
$123.03
Median
$218.78
Typical High
$426.58

Where Minnesota sits

The same service costs 3.6 times more in Kansas than in Washington, DC. Every bar is a state, most expensive first. Pick one to see its carriers and full range.

Minnesota $339 · 3rd of 51
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.