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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 October 2026.

How much does TLSO, Flexible, Sacrococcygeal to T-9, Off-the-Shelf cost?

$204

Typical negotiated rate. In West Virginia, October 2026.

Insurers have agreed to pay about $204 for this service. The price depends on where it is billed: about $204 from a physician practice, and about $275 from a hospital or other facility.

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 4 insurance carriers under federal price transparency rules.

Prices by location type

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$204$200 to $302
FacilityA hospital or hospital-owned outpatient department$275$275 to $295

How much rates vary

Facilitymedian $275 · 10th to 90th $275 to $355Professionalmedian $204 · 10th to 90th $166 to $479
$200$500$1Kfacility $275professional $204

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

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Professional
Modifier
None
Typical Low
$165.96
Median
$165.96
Typical High
$165.96
Aetna
Setting
Professional
Modifier
52 · Reduced service
Typical Low
$83.18
Median
$83.18
Typical High
$83.18
Aetna
Setting
Professional
Modifier
53 · Discontinued
Typical Low
$33.11
Median
$33.11
Typical High
$33.11
Aetna
Setting
Professional
Modifier
55 · Aftercare only
Typical Low
$24.55
Median
$24.55
Typical High
$24.55
Aetna
Setting
Professional
Modifier
56 · Pre-op care only
Typical Low
$16.60
Median
$16.60
Typical High
$16.60
CareSource
Setting
Facility
Modifier
None
Typical Low
$169.82
Median
$169.82
Typical High
$169.82
CareSource
Setting
Professional
Modifier
None
Typical Low
$181.97
Median
$181.97
Typical High
$316.23
Cigna
Setting
Facility
Modifier
None
Typical Low
$275.42
Median
$275.42
Typical High
$363.08
Cigna
Setting
Professional
Modifier
None
Typical Low
$204.17
Median
$204.17
Typical High
$1,202.26
United
Setting
Facility
Modifier
None
Typical Low
$354.81
Median
$354.81
Typical High
$354.81
United
Setting
Professional
Modifier
None
Typical Low
$186.21
Median
$257.04
Typical High
$478.63

Where West Virginia 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.

West Virginia· 39th of 51

$204

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.