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

North Carolina 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 $282 · 10th–90th $145$6460%20%40%10th90th$282Professionalmedian $263 · 10th–90th $141$2820%50%10th90th$263$0.5$2.0$10.0$50.0$200.0$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
Facility
Modifier
Global
Typical Low
$281.84
Median
$281.84
Typical High
$281.84
Aetna
Setting
Professional
Modifier
Global
Typical Low
$138.04
Median
$281.84
Typical High
$281.84
BCBS
Setting
Facility
Modifier
Global
Typical Low
$354.81
Median
$426.58
Typical High
$645.65
BCBS
Setting
Professional
Modifier
Global
Typical Low
$263.03
Median
$263.03
Typical High
$288.40
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
$288.40
Medcost
Setting
Facility
Modifier
Global
Typical Low
$114.82
Median
$281.84
Typical High
$436.52
United
Setting
Facility
Modifier
Global
Typical Low
$144.54
Median
$269.15
Typical High
$269.15
United
Setting
Professional
Modifier
Global
Typical Low
$141.25
Median
$208.93
Typical High
$295.12
Wellcare
Setting
Facility
Modifier
Global
Typical Low
$1,174.90
Median
$1,174.90
Typical High
$1,174.90
Wellcare
Setting
Professional
Modifier
Global
Typical Low
$1,737.80
Median
$1,737.80
Typical High
$1,737.80