go back

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

Oregon 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 $115 · 10th–90th $115$3390%50%90th$115Professionalmedian $170 · 10th–90th $115$3240%10%20%10th90th$170$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
Professional
Modifier
Global
Typical Low
$120.23
Median
$162.18
Typical High
$234.42
Cigna
Setting
Facility
Modifier
Global
Typical Low
$275.42
Median
$275.42
Typical High
$275.42
Cigna
Setting
Professional
Modifier
Global
Typical Low
$204.17
Median
$204.17
Typical High
$204.17
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$89.13
Median
$257.04
Typical High
$309.03
Moda Health
Setting
Facility
Modifier
Global
Typical Low
$117.49
Median
$263.03
Typical High
$309.03
Moda Health
Setting
Professional
Modifier
Global
Typical Low
$112.20
Median
$169.82
Typical High
$323.59
Pacific Source
Setting
Facility
Modifier
Global
Typical Low
$114.82
Median
$114.82
Typical High
$323.59
Providence
Setting
Facility
Modifier
Global
Typical Low
$117.49
Median
$138.04
Typical High
$354.81
Providence
Setting
Professional
Modifier
Global
Typical Low
$79.43
Median
$181.97
Typical High
$323.59
Regence BlueShield
Setting
Facility
Modifier
Global
Typical Low
$114.82
Median
$331.13
Typical High
$630.96
Regence BlueShield
Setting
Professional
Modifier
Global
Typical Low
$117.49
Median
$131.83
Typical High
$181.97
United
Setting
Facility
Modifier
Global
Typical Low
$0.30
Median
$186.21
Typical High
$501.19
United
Setting
Professional
Modifier
Global
Typical Low
$114.82
Median
$186.21
Typical High
$295.12