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

New Hampshire 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?

$229

Typical negotiated rate. In New Hampshire, July 2026.

Insurers have agreed to pay about $229 for this service. The price depends on where it is billed: about $229 from a physician practice, and about $282 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 6 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$229$229 to $240
FacilityA hospital or hospital-owned outpatient department$282$269 to $288

How much rates vary

Facilitymedian $282 · 10th to 90th $240 to $331Professionalmedian $229 · 10th to 90th $178 to $288
$200$500facility $282professional $229

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
$239.88
Median
$239.88
Typical High
$288.40
Aetna
Setting
Professional
Modifier
Global
Typical Low
$120.23
Median
$239.88
Typical High
$288.40
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$269.15
Median
$288.40
Typical High
$331.13
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$239.88
Median
$239.88
Typical High
$239.88
Cigna
Setting
Facility
Modifier
Global
Typical Low
$275.42
Median
$275.42
Typical High
$275.42
Cigna
Setting
Professional
Modifier
Global
Typical Low
$204.17
Median
$204.17
Typical High
$275.42
Harvard Pilgrim
Setting
Professional
Modifier
Global
Typical Low
$229.09
Median
$229.09
Typical High
$426.58
United
Setting
Facility
Modifier
Global
Typical Low
$117.49
Median
$190.55
Typical High
$234.42
United
Setting
Professional
Modifier
Global
Typical Low
$134.90
Median
$229.09
Typical High
$331.13
Well Sense
Setting
Facility
Modifier
Global
Typical Low
$251.19
Median
$251.19
Typical High
$323.59

Where New Hampshire 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.

New Hampshire· 14th of 51

$229

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.