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

Ohio 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 $240 · 10th–90th $158$3980%20%40%10th90th$240Professionalmedian $204 · 10th–90th $120$3470%10%20%10th90th$204$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
$120.23
Median
$234.42
Typical High
$281.84
Aetna
Setting
Professional
Modifier
Global
Typical Low
$120.23
Median
$141.25
Typical High
$208.93
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$229.09
Median
$239.88
Typical High
$489.78
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$194.98
Median
$245.47
Typical High
$389.05
CareSource
Setting
Facility
Modifier
Global
Typical Low
$131.83
Median
$223.87
Typical High
$316.23
CareSource
Setting
Professional
Modifier
Global
Typical Low
$169.82
Median
$234.42
Typical High
$354.81
Cigna
Setting
Facility
Modifier
Global
Typical Low
$275.42
Median
$275.42
Typical High
$309.03
Cigna
Setting
Professional
Modifier
Global
Typical Low
$204.17
Median
$204.17
Typical High
$295.12
Medical Mutual of Ohio
Setting
Facility
Modifier
Global
Typical Low
$275.42
Median
$275.42
Typical High
$295.12
Medical Mutual of Ohio
Setting
Professional
Modifier
Global
Typical Low
$204.17
Median
$204.17
Typical High
$204.17
Molina
Setting
Professional
Modifier
Global
Typical Low
$147.91
Median
$208.93
Typical High
$295.12
SummaCare
Setting
Professional
Modifier
Global
Typical Low
$346.74
Median
$426.58
Typical High
$812.83
United
Setting
Facility
Modifier
Global
Typical Low
$147.91
Median
$218.78
Typical High
$354.81
United
Setting
Professional
Modifier
Global
Typical Low
$123.03
Median
$199.53
Typical High
$295.12