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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 July 2026.

Facilitymedian $309 · 10th–90th $209$3890%50%10th90th$309Professionalmedian $282 · 10th–90th $209$3160%20%40%10th90th$282$50.0$100.0$200.0$500.0$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
$208.93
Median
$309.03
Typical High
$309.03
Aetna
Setting
Professional
Modifier
Global
Typical Low
$208.93
Median
$234.42
Typical High
$436.52
BCBS
Setting
Professional
Modifier
Global
Typical Low
$213.80
Median
$281.84
Typical High
$309.03
Cigna
Setting
Facility
Modifier
Global
Typical Low
$275.42
Median
$275.42
Typical High
$275.42
Cigna
Setting
Professional
Modifier
Global
Typical Low
$275.42
Median
$295.12
Typical High
$371.54
Medica
Setting
Facility
Modifier
Global
Typical Low
$93.33
Median
$309.03
Typical High
$912.01
Medica
Setting
Professional
Modifier
Global
Typical Low
$169.82
Median
$208.93
Typical High
$338.84
United
Setting
Facility
Modifier
Global
Typical Low
$186.21
Median
$186.21
Typical High
$501.19
United
Setting
Professional
Modifier
Global
Typical Low
$154.88
Median
$263.03
Typical High
$338.84