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

West 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.

Facilitymedian $166 · 10th–90th $166$3550%50%90th$166Professionalmedian $166 · 10th–90th $115$2880%20%10th90th$166$100.0$200.0$500.0$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. Small sample; interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$165.96
Median
$165.96
Typical High
$165.96
Aetna
Setting
Professional
Modifier
Global
Typical Low
$114.82
Median
$165.96
Typical High
$199.53
CareSource
Setting
Facility
Modifier
Global
Typical Low
$169.82
Median
$169.82
Typical High
$354.81
CareSource
Setting
Professional
Modifier
Global
Typical Low
$181.97
Median
$181.97
Typical High
$316.23
Cigna
Setting
Facility
Modifier
Global
Typical Low
$275.42
Median
$363.08
Typical High
$363.08
Cigna
Setting
Professional
Modifier
Global
Typical Low
$204.17
Median
$204.17
Typical High
$1,202.26
United
Setting
Facility
Modifier
Global
Typical Low
$173.78
Median
$186.21
Typical High
$354.81
United
Setting
Professional
Modifier
Global
Typical Low
$173.78
Median
$223.87
Typical High
$354.81