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

New Mexico 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 $186 · 10th–90th $83$3550%10%10th90th$186Professionalmedian $224 · 10th–90th $100$3720%20%10th90th$224$50.0$100.0$200.0$500.0

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Small sample; interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$151.36
Median
$151.36
Typical High
$151.36
Aetna
Setting
Professional
Modifier
Global
Typical Low
$100.00
Median
$234.42
Typical High
$501.19
BCBS
Setting
Professional
Modifier
Global
Typical Low
$147.91
Median
$194.98
Typical High
$223.87
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
$380.19
Molina
Setting
Professional
Modifier
Global
Typical Low
$199.53
Median
$245.47
Typical High
$436.52
Providence
Setting
Facility
Modifier
Global
Typical Low
$83.18
Median
$144.54
Typical High
$269.15
Providence
Setting
Professional
Modifier
Global
Typical Low
$173.78
Median
$204.17
Typical High
$275.42
United
Setting
Facility
Modifier
Global
Typical Low
$173.78
Median
$204.17
Typical High
$416.87
United
Setting
Professional
Modifier
Global
Typical Low
$173.78
Median
$186.21
Typical High
$295.12