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TLSO, Triplanar Control, Two Rigid Shells, Prefabricated

Louisiana rates for HCPCS L0458

Thoracic-lumbar-sacral orthosis (TLSO), triplanar control, modular segmented spinal system, two rigid plastic shells, posterior extends from the sacrococcygeal junction and terminates just inferior to the scapular spine, anterior extends from the symphysis pubis to the xiphoid, soft liner, restricts gross trunk motion in the sagittal, coronal, and transverse planes, lateral strength is provided by overlapping plastic and stabilizing closures, includes straps and closures, prefabricated, includes fitting and adjustment

Rates data updated July 2026.

Facilitymedian $891 · 10th–90th $575$1,9500%20%10th90th$891Professionalmedian $589 · 10th–90th $447$7940%20%40%10th90th$589$1.0$5.0$20.0$100.0$500.0$2.0K$10.0K

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
$616.60
Median
$616.60
Typical High
$616.60
Aetna
Setting
Professional
Modifier
Global
Typical Low
$478.63
Median
$588.84
Typical High
$831.76
BCBS
Setting
Facility
Modifier
Global
Typical Low
$933.25
Median
$1,621.81
Typical High
$2,238.72
BCBS
Setting
Professional
Modifier
Global
Typical Low
$758.58
Median
$758.58
Typical High
$758.58
Christus
Setting
Facility
Modifier
Global
Typical Low
$39.81
Median
$39.81
Typical High
$39.81
Cigna
Setting
Facility
Modifier
Global
Typical Low
$691.83
Median
$691.83
Typical High
$691.83
Cigna
Setting
Professional
Modifier
Global
Typical Low
$512.86
Median
$512.86
Typical High
$1,047.13
United
Setting
Facility
Modifier
Global
Typical Low
$363.08
Median
$891.25
Typical High
$1,318.26
United
Setting
Professional
Modifier
Global
Typical Low
$316.23
Median
$501.19
Typical High
$691.83