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

Mississippi 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 $302 · 10th–90th $155$4170%20%40%10th90th$302Professionalmedian $204 · 10th–90th $138$2450%20%10th90th$204$100.0$200.0$500.0

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
$154.88
Median
$154.88
Typical High
$239.88
Aetna
Setting
Professional
Modifier
Global
Typical Low
$138.04
Median
$181.97
Typical High
$245.47
BCBS
Setting
Facility
Modifier
Global
Typical Low
$302.00
Median
$302.00
Typical High
$302.00
BCBS
Setting
Professional
Modifier
Global
Typical Low
$263.03
Median
$263.03
Typical High
$263.03
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
$275.42
United
Setting
Facility
Modifier
Global
Typical Low
$131.83
Median
$251.19
Typical High
$501.19
United
Setting
Professional
Modifier
Global
Typical Low
$123.03
Median
$199.53
Typical High
$309.03