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

South Dakota 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 October 2026.

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

$295

Typical negotiated rate. In South Dakota, October 2026.

Insurers have agreed to pay about $295 for this service. The price depends on where it is billed: about $295 from a physician practice, and about $398 from a hospital or other facility.

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 7 insurance carriers under federal price transparency rules.

Prices by location type

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$295$234 to $355
FacilityA hospital or hospital-owned outpatient department$398$295 to $398

How much rates vary

Facilitymedian $398 · 10th to 90th $275 to $646Professionalmedian $295 · 10th to 90th $182 to $372
$50$100$200$500$1Kfacility $398professional $295

Distribution of negotiated rates across all payers (price axis is log-scale). Small sample; interpret with caution. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
None
Typical Low
$309.03
Median
$309.03
Typical High
$309.03
Aetna
Setting
Professional
Modifier
None
Typical Low
$181.97
Median
$234.42
Typical High
$234.42
Cigna
Setting
Facility
Modifier
None
Typical Low
$275.42
Median
$275.42
Typical High
$380.19
Cigna
Setting
Professional
Modifier
None
Typical Low
$295.12
Median
$371.54
Typical High
$380.19
Medica
Setting
Facility
Modifier
None
Typical Low
$295.12
Median
$398.11
Typical High
$645.65
Medica
Setting
Professional
Modifier
None
Typical Low
$169.82
Median
$257.04
Typical High
$1,737.80
Midlands
Setting
Professional
Modifier
None
Typical Low
$371.54
Median
$371.54
Typical High
$380.19
Midlands
Setting
Professional
Modifier
None
Typical Low
$380.19
Median
$380.19
Typical High
$758.58
Sanford Health Plan
Setting
Professional
Modifier
None
Typical Low
$257.04
Median
$257.04
Typical High
$354.81
United
Setting
Professional
Modifier
None
Typical Low
$154.88
Median
$208.93
Typical High
$331.13
Wellmark
Setting
Professional
Modifier
None
Typical Low
$338.84
Median
$338.84
Typical High
$338.84

Where South Dakota sits

The same service costs 2.6 times more in Hawaii than in Utah. 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.

South Dakota· 4th of 51

$295

HI $417UT $162

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.