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TLSO, Rigid Posterior Panel and Soft Apron, Custom Fitted

Montana rates for HCPCS L0456

Thoracic-lumbar-sacral orthosis (TLSO), flexible, provides trunk support, thoracic region, rigid posterior panel and soft anterior apron, extends from the sacrococcygeal junction and terminates just inferior to the scapular spine, restricts gross trunk motion in the sagittal plane, produces intracavitary pressure to reduce load on the intervertebral disks, includes straps and closures, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise

Rates data updated July 2026.

Facilitymedian $1,175 · 10th–90th $741$1,4790%20%10th90th$1,175Professionalmedian $912 · 10th–90th $347$1,4790%10%20%10th90th$912$100.0$200.0$500.0$1.0K$2.0K$5.0K

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
Professional
Modifier
Global
Typical Low
$346.74
Median
$630.96
Typical High
$5,128.61
BCBS
Setting
Professional
Modifier
Global
Typical Low
$1,174.90
Median
$1,174.90
Typical High
$1,174.90
Cigna
Setting
Facility
Modifier
Global
Typical Low
$741.31
Median
$1,258.93
Typical High
$1,258.93
Cigna
Setting
Professional
Modifier
Global
Typical Low
$741.31
Median
$1,258.93
Typical High
$1,258.93
MountainHealth Co-op
Setting
Facility
Modifier
Global
Typical Low
$933.25
Median
$1,174.90
Typical High
$2,290.87
MountainHealth Co-op
Setting
Professional
Modifier
Global
Typical Low
$933.25
Median
$1,174.90
Typical High
$2,290.87
Providence
Setting
Facility
Modifier
Global
Typical Low
$562.34
Median
$1,122.02
Typical High
$1,445.44
Providence
Setting
Professional
Modifier
Global
Typical Low
$79.43
Median
$954.99
Typical High
$1,258.93
United
Setting
Facility
Modifier
Global
Typical Low
$524.81
Median
$602.56
Typical High
$660.69
United
Setting
Professional
Modifier
Global
Typical Low
$489.78
Median
$537.03
Typical High
$812.83