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

North Dakota 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?

$288

Typical negotiated rate. In North Dakota, October 2026.

Insurers have agreed to pay about $288 for this service. The price depends on where it is billed: about $288 from a physician practice, and about $309 from a hospital or other facility.

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 5 insurance carriers under federal price transparency rules.

Prices by location type

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$288$219 to $295
FacilityA hospital or hospital-owned outpatient department$309$275 to $309

How much rates vary

Facilitymedian $309 · 10th to 90th $182 to $525Professionalmedian $288 · 10th to 90th $186 to $339
$100$200$500$1Kfacility $309professional $288

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
Facility
Modifier
None
Typical Low
$309.03
Median
$309.03
Typical High
$309.03
Aetna
Setting
Professional
Modifier
None
Typical Low
$181.97
Median
$309.03
Typical High
$309.03
BCBS North Dakota
Setting
Professional
Modifier
None
Typical Low
$218.78
Median
$288.40
Typical High
$295.12
BCBS North Dakota
Setting
Professional
Modifier
22 · Increased work
Typical Low
$263.03
Median
$346.74
Typical High
$346.74
Cigna
Setting
Facility
Modifier
None
Typical Low
$275.42
Median
$275.42
Typical High
$275.42
Cigna
Setting
Professional
Modifier
None
Typical Low
$275.42
Median
$295.12
Typical High
$371.54
Medica
Setting
Facility
Modifier
None
Typical Low
$93.33
Median
$309.03
Typical High
$912.01
Medica
Setting
Professional
Modifier
None
Typical Low
$169.82
Median
$208.93
Typical High
$338.84
United
Setting
Professional
Modifier
None
Typical Low
$104.71
Median
$208.93
Typical High
$338.84

Where North Dakota 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.

North Dakota· 8th of 51

$288

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.