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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 July 2026.

Facilitymedian $275 · 10th–90th $166$1,1750%20%10th90th$275Professionalmedian $158 · 10th–90th $145$2750%20%10th90th$158$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
$151.36
Median
$165.96
Typical High
$263.03
Aetna
Setting
Professional
Modifier
Global
Typical Low
$144.54
Median
$158.49
Typical High
$251.19
BCBS
Setting
Professional
Modifier
Global
Typical Low
$263.03
Median
$263.03
Typical High
$281.84
Cigna
Setting
Facility
Modifier
Global
Typical Low
$275.42
Median
$275.42
Typical High
$323.59
Cigna
Setting
Professional
Modifier
Global
Typical Low
$204.17
Median
$204.17
Typical High
$275.42
Lucent Health
Setting
Facility
Modifier
Global
Typical Low
$1,174.90
Median
$1,174.90
Typical High
$1,174.90
Lucent Health
Setting
Professional
Modifier
Global
Typical Low
$1,737.80
Median
$1,737.80
Typical High
$1,737.80
United
Setting
Facility
Modifier
Global
Typical Low
$144.54
Median
$208.93
Typical High
$295.12
United
Setting
Professional
Modifier
Global
Typical Low
$131.83
Median
$199.53
Typical High
$275.42