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

Tennessee 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?

$209

Typical negotiated rate. In Tennessee, October 2026.

Insurers have agreed to pay about $209 for this service. Most negotiated rates run $186 to $275.

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 5 insurance carriers under federal price transparency rules.

How much rates vary

Facilitymedian $275 · 10th to 90th $275 to $295Professionalmedian $209 · 10th to 90th $148 to $1,738
$200$500$1Kfacility $275professional $209

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

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
None
Typical Low
$151.36
Median
$151.36
Typical High
$151.36
Aetna
Setting
Professional
Modifier
None
Typical Low
$147.91
Median
$151.36
Typical High
$165.96
Aetna
Setting
Professional
Modifier
52 · Reduced service
Typical Low
$74.13
Median
$75.86
Typical High
$83.18
Aetna
Setting
Professional
Modifier
53 · Discontinued
Typical Low
$29.51
Median
$30.20
Typical High
$33.11
Aetna
Setting
Professional
Modifier
55 · Aftercare only
Typical Low
$22.39
Median
$22.39
Typical High
$24.55
Aetna
Setting
Professional
Modifier
56 · Pre-op care only
Typical Low
$14.79
Median
$15.14
Typical High
$16.60
BCBS Tennessee
Setting
Professional
Modifier
None
Typical Low
$251.19
Median
$263.03
Typical High
$263.03
Cigna
Setting
Facility
Modifier
None
Typical Low
$275.42
Median
$275.42
Typical High
$295.12
Cigna
Setting
Professional
Modifier
None
Typical Low
$204.17
Median
$204.17
Typical High
$275.42
Lucent Health
Setting
Professional
Modifier
None
Typical Low
$1,737.80
Median
$1,778.28
Typical High
$1,778.28
United
Setting
Professional
Modifier
None
Typical Low
$131.83
Median
$199.53
Typical High
$263.03

Where Tennessee 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.

Tennessee· 35th of 51

$209

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.