go back

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

Texas 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 $224 · 10th–90th $132$7410%10%20%10th90th$224Professionalmedian $170 · 10th–90th $132$2450%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
Facility
Modifier
Global
Typical Low
$138.04
Median
$144.54
Typical High
$177.83
Aetna
Setting
Professional
Modifier
Global
Typical Low
$131.83
Median
$154.88
Typical High
$234.42
BCBS
Setting
Professional
Modifier
Global
Typical Low
$213.80
Median
$213.80
Typical High
$213.80
Christus
Setting
Facility
Modifier
Global
Typical Low
$79.43
Median
$251.19
Typical High
$251.19
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
$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
Moda Health
Setting
Facility
Modifier
Global
Typical Low
$114.82
Median
$239.88
Typical High
$524.81
Moda Health
Setting
Professional
Modifier
Global
Typical Low
$112.20
Median
$154.88
Typical High
$251.19
Providence
Setting
Facility
Modifier
Global
Typical Low
$114.82
Median
$251.19
Typical High
$524.81
Providence
Setting
Professional
Modifier
Global
Typical Low
$204.17
Median
$204.17
Typical High
$275.42
United
Setting
Facility
Modifier
Global
Typical Low
$154.88
Median
$204.17
Typical High
$354.81
United
Setting
Professional
Modifier
Global
Typical Low
$154.88
Median
$234.42
Typical High
$295.12
Wellpoint
Setting
Professional
Modifier
Global
Typical Low
$223.87
Median
$251.19
Typical High
$346.74