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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.

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

$186

Typical negotiated rate. In New Jersey, July 2026.

Insurers have agreed to pay about $186 for this service. The price depends on where it is billed: about $186 from a physician practice, and about $145 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 5 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$186$138 to $234
FacilityA hospital or hospital-owned outpatient department$145$145 to $234

How much rates vary

Facilitymedian $145 · 10th to 90th $145 to $275Professionalmedian $186 · 10th to 90th $115 to $339
$100$200$500facility $145professional $186

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
$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

Where New Jersey 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 Jersey· 32nd of 51

$186

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.