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

Nebraska 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 $275 · 10th–90th $186$1,1480%10%20%10th90th$275Professionalmedian $158 · 10th–90th $145$2510%20%40%10th90th$158$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
$190.55
Median
$190.55
Typical High
$190.55
Aetna
Setting
Professional
Modifier
Global
Typical Low
$144.54
Median
$158.49
Typical High
$234.42
BCBS
Setting
Professional
Modifier
Global
Typical Low
$223.87
Median
$245.47
Typical High
$251.19
Cigna
Setting
Facility
Modifier
Global
Typical Low
$275.42
Median
$275.42
Typical High
$380.19
Cigna
Setting
Professional
Modifier
Global
Typical Low
$275.42
Median
$371.54
Typical High
$851.14
Medica
Setting
Facility
Modifier
Global
Typical Low
$190.55
Median
$338.84
Typical High
$1,148.15
Medica
Setting
Professional
Modifier
Global
Typical Low
$138.04
Median
$208.93
Typical High
$323.59
Midlands
Setting
Professional
Modifier
Global
Typical Low
$371.54
Median
$371.54
Typical High
$912.01
Midlands
Setting
Facility
Modifier
Global
Typical Low
$380.19
Median
$380.19
Typical High
$380.19
Midlands
Setting
Professional
Modifier
Global
Typical Low
$512.86
Median
$851.14
Typical High
$912.01
United
Setting
Facility
Modifier
Global
Typical Low
$162.18
Median
$263.03
Typical High
$354.81
United
Setting
Professional
Modifier
Global
Typical Low
$131.83
Median
$208.93
Typical High
$316.23