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

Montana 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?

$186

Typical negotiated rate. In Montana, July 2026.

Insurers have agreed to pay about $186 for this service. The price depends on where it is billed: about $178 from a physician practice, and about $200 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$178$145 to $275
FacilityA hospital or hospital-owned outpatient department$200$166 to $355

How much rates vary

Facilitymedian $200 · 10th to 90th $166 to $479Professionalmedian $178 · 10th to 90th $78 to $501
$100$200$500facility $200professional $178

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
$77.62
Median
$162.18
Typical High
$501.19
BCBS
Setting
Professional
Modifier
Global
Typical Low
$331.13
Median
$331.13
Typical High
$331.13
Cigna
Setting
Facility
Modifier
Global
Typical Low
$275.42
Median
$363.08
Typical High
$363.08
Cigna
Setting
Professional
Modifier
Global
Typical Low
$204.17
Median
$363.08
Typical High
$363.08
MountainHealth Co-op
Setting
Facility
Modifier
Global
Typical Low
$165.96
Median
$194.98
Typical High
$478.63
MountainHealth Co-op
Setting
Professional
Modifier
Global
Typical Low
$165.96
Median
$194.98
Typical High
$478.63
Providence
Setting
Facility
Modifier
Global
Typical Low
$114.82
Median
$275.42
Typical High
$398.11
Providence
Setting
Professional
Modifier
Global
Typical Low
$79.43
Median
$218.78
Typical High
$363.08
United
Setting
Facility
Modifier
Global
Typical Low
$186.21
Median
$199.53
Typical High
$234.42
United
Setting
Professional
Modifier
Global
Typical Low
$173.78
Median
$186.21
Typical High
$295.12

Where Montana 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.

Montana· 33rd of 51

$186

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.