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

Pennsylvania 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.

How much does TLSO, Flexible, Sacrococcygeal to T-9, Off-the-Shelf cost?

$166

Typical negotiated rate. In Pennsylvania, July 2026.

Insurers have agreed to pay about $166 for this service. The price depends on where it is billed: about $162 from a physician practice, and about $295 from a hospital or other facility. The two figures are alternatives, not parts of one bill.

These are rates insurers have negotiated with providers, not the amount a patient is billed. What you owe depends on your plan's deductible and coinsurance. Based on rates published by 8 insurance carriers under federal price transparency rules.

Where it's billed changes the price

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$162$138 to $204
FacilityA hospital or hospital-owned outpatient department$295$120 to $468

How much rates vary

Facilitymedian $295 · 10th to 90th $120 to $468Professionalmedian $162 · 10th to 90th $120 to $251
$100$500$2K$10K$50Kfacility $295professional $162

Distribution of negotiated rates across all payers (price axis is log-scale). Each curve is scaled to its own total: facility and professional rates are different services, shown together to compare where they cluster. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$120.23
Median
$120.23
Typical High
$467.74
Aetna
Setting
Professional
Modifier
Global
Typical Low
$120.23
Median
$144.54
Typical High
$245.47
Capital Blue Cross
Setting
Facility
Modifier
Global
Typical Low
$5,011.87
Median
$8,511.38
Typical High
$77,624.71
Capital Blue Cross
Setting
Professional
Modifier
Global
Typical Low
$229.09
Median
$229.09
Typical High
$229.09
Cigna
Setting
Facility
Modifier
Global
Typical Low
$275.42
Median
$275.42
Typical High
$446.68
Cigna
Setting
Professional
Modifier
Global
Typical Low
$204.17
Median
$204.17
Typical High
$275.42
Emblem Health
Setting
Professional
Modifier
Global
Typical Low
$218.78
Median
$309.03
Typical High
$446.68
Geisinger
Setting
Facility
Modifier
Global
Typical Low
$234.42
Median
$234.42
Typical High
$234.42
Geisinger
Setting
Professional
Modifier
Global
Typical Low
$141.25
Median
$165.96
Typical High
$234.42
Martin's Point
Setting
Facility
Modifier
Global
Typical Low
$120.23
Median
$120.23
Typical High
$467.74
Martin's Point
Setting
Professional
Modifier
Global
Typical Low
$120.23
Median
$144.54
Typical High
$251.19
UPMC Health Plan
Setting
Facility
Modifier
Global
Typical Low
$295.12
Median
$295.12
Typical High
$831.76
UPMC Health Plan
Setting
Professional
Modifier
Global
Typical Low
$295.12
Median
$295.12
Typical High
$295.12
United
Setting
Facility
Modifier
Global
Typical Low
$173.78
Median
$416.87
Typical High
$416.87
United
Setting
Professional
Modifier
Global
Typical Low
$134.90
Median
$204.17
Typical High
$354.81

Where Pennsylvania sits

The same service costs 3.6 times more in Kansas than in Washington, DC. Every bar is a state, most expensive first. Touch or drag across it to read any state, then open that state for its carriers and full range.

Pennsylvania· 44th of 51

$166

KS $417DC $115

Median negotiated rate in each state, from every insurer that publishes one. States where no insurer publishes a rate for this service are not shown.