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

Nevada 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 $68 · 10th–90th $68$6460%50%90th$68Professionalmedian $162 · 10th–90th $68$3390%10%10th90th$162$5.0$10.0$20.0$50.0$100.0$200.0$500.0

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
$67.61
Median
$67.61
Typical High
$645.65
Aetna
Setting
Professional
Modifier
Global
Typical Low
$67.61
Median
$114.82
Typical High
$501.19
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$117.49
Median
$117.49
Typical High
$125.89
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$239.88
Median
$239.88
Typical High
$269.15
Cigna
Setting
Facility
Modifier
Global
Typical Low
$199.53
Median
$275.42
Typical High
$323.59
Cigna
Setting
Professional
Modifier
Global
Typical Low
$204.17
Median
$204.17
Typical High
$275.42
Select Health
Setting
Facility
Modifier
Global
Typical Low
$117.49
Median
$117.49
Typical High
$117.49
Select Health
Setting
Professional
Modifier
Global
Typical Low
$81.28
Median
$107.15
Typical High
$338.84
United
Setting
Facility
Modifier
Global
Typical Low
$144.54
Median
$186.21
Typical High
$234.42
United
Setting
Professional
Modifier
Global
Typical Low
$89.13
Median
$186.21
Typical High
$295.12