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

New Jersey 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 $145 · 10th–90th $145$2750%50%90th$145Professionalmedian $186 · 10th–90th $115$3390%10%10th90th$186$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. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$144.54
Median
$144.54
Typical High
$144.54
Aetna
Setting
Professional
Modifier
Global
Typical Low
$100.00
Median
$158.49
Typical High
$234.42
Cigna
Setting
Facility
Modifier
Global
Typical Low
$234.42
Median
$275.42
Typical High
$275.42
Cigna
Setting
Professional
Modifier
Global
Typical Low
$204.17
Median
$204.17
Typical High
$275.42
Emblem Health
Setting
Professional
Modifier
Global
Typical Low
$154.88
Median
$245.47
Typical High
$338.84
Horizon BCBS
Setting
Professional
Modifier
Global
Typical Low
$229.09
Median
$338.84
Typical High
$338.84
United
Setting
Facility
Modifier
Global
Typical Low
$162.18
Median
$234.42
Typical High
$338.84
United
Setting
Professional
Modifier
Global
Typical Low
$162.18
Median
$204.17
Typical High
$316.23