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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 October 2026.

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

$204

Typical negotiated rate. In New Mexico, October 2026.

Insurers have agreed to pay about $204 for this service. The price depends on where it is billed: about $204 from a physician practice, and about $204 from a hospital or other facility.

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.

Prices by location type

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$204$186 to $245
FacilityA hospital or hospital-owned outpatient department$204$83.18 to $275

How much rates vary

Facilitymedian $204 · 10th to 90th $83 to $355Professionalmedian $204 · 10th to 90th $166 to $295
$100$200facility $204professional $204

Distribution of negotiated rates across all payers (price axis is log-scale). Small sample; interpret with caution. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
None
Typical Low
$151.36
Median
$151.36
Typical High
$151.36
Aetna
Setting
Professional
Modifier
None
Typical Low
$125.89
Median
$234.42
Typical High
$234.42
BCBS New Mexico
Setting
Professional
Modifier
None
Typical Low
$147.91
Median
$194.98
Typical High
$281.84
Cigna
Setting
Facility
Modifier
None
Typical Low
$275.42
Median
$275.42
Typical High
$275.42
Cigna
Setting
Professional
Modifier
None
Typical Low
$204.17
Median
$204.17
Typical High
$275.42
Molina
Setting
Professional
Modifier
None
Typical Low
$199.53
Median
$245.47
Typical High
$371.54
Providence
Setting
Facility
Modifier
None
Typical Low
$83.18
Median
$83.18
Typical High
$275.42
Providence
Setting
Professional
Modifier
None
Typical Low
$173.78
Median
$204.17
Typical High
$275.42
United
Setting
Facility
Modifier
None
Typical Low
$354.81
Median
$354.81
Typical High
$416.87
United
Setting
Professional
Modifier
None
Typical Low
$173.78
Median
$186.21
Typical High
$295.12

Where New Mexico sits

The same service costs 2.6 times more in Hawaii than in Utah. 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 Mexico· 37th of 51

$204

HI $417UT $162

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.