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

Virginia 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?

$234

Typical negotiated rate. In Virginia, July 2026.

Insurers have agreed to pay about $234 for this service. The price depends on where it is billed: about $204 from a physician practice, and about $269 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$204$200 to $245
FacilityA hospital or hospital-owned outpatient department$269$240 to $316

How much rates vary

Facilitymedian $269 · 10th to 90th $186 to $417Professionalmedian $204 · 10th to 90th $120 to $363
$100$200$500$1Kfacility $269professional $204

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
$114.82
Median
$199.53
Typical High
$199.53
Aetna
Setting
Professional
Modifier
Global
Typical Low
$114.82
Median
$199.53
Typical High
$234.42
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$269.15
Median
$269.15
Typical High
$288.40
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$239.88
Median
$239.88
Typical High
$501.19
CareFirst
Setting
Professional
Modifier
Global
Typical Low
$223.87
Median
$257.04
Typical High
$257.04
Cigna
Setting
Facility
Modifier
Global
Typical Low
$181.97
Median
$275.42
Typical High
$275.42
Cigna
Setting
Professional
Modifier
Global
Typical Low
$204.17
Median
$204.17
Typical High
$204.17
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$177.83
Median
$275.42
Typical High
$436.52
Medcost
Setting
Facility
Modifier
Global
Typical Low
$114.82
Median
$223.87
Typical High
$398.11
Medcost
Setting
Professional
Modifier
Global
Typical Low
$223.87
Median
$251.19
Typical High
$338.84
Sentara
Setting
Facility
Modifier
Global
Typical Low
$204.17
Median
$316.23
Typical High
$537.03
Sentara
Setting
Professional
Modifier
Global
Typical Low
$204.17
Median
$316.23
Typical High
$537.03
United
Setting
Facility
Modifier
Global
Typical Low
$131.83
Median
$190.55
Typical High
$416.87
United
Setting
Professional
Modifier
Global
Typical Low
$186.21
Median
$204.17
Typical High
$323.59

Where Virginia 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.

Virginia· 11th of 51

$234

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.