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

New York 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?

$240

Typical negotiated rate. In New York, July 2026.

Insurers have agreed to pay about $240 for this service. The price depends on where it is billed: about $240 from a physician practice, and about $240 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 9 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$240$178 to $269
FacilityA hospital or hospital-owned outpatient department$240$186 to $309

How much rates vary

Facilitymedian $240 · 10th to 90th $145 to $417Professionalmedian $240 · 10th to 90th $141 to $437
$100$500$2K$10K$50Kfacility $240professional $240

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
$141.25
Median
$177.83
Typical High
$316.23
Aetna
Setting
Professional
Modifier
Global
Typical Low
$120.23
Median
$173.78
Typical High
$239.88
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$234.42
Median
$234.42
Typical High
$467.74
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$239.88
Median
$239.88
Typical High
$602.56
CDPHP
Setting
Facility
Modifier
Global
Typical Low
$275.42
Median
$295.12
Typical High
$295.12
CDPHP
Setting
Professional
Modifier
Global
Typical Low
$295.12
Median
$295.12
Typical High
$295.12
Cigna
Setting
Facility
Modifier
Global
Typical Low
$275.42
Median
$275.42
Typical High
$363.08
Cigna
Setting
Professional
Modifier
Global
Typical Low
$204.17
Median
$204.17
Typical High
$288.40
Emblem Health
Setting
Facility
Modifier
Global
Typical Low
$234.42
Median
$389.05
Typical High
$912.01
Emblem Health
Setting
Professional
Modifier
Global
Typical Low
$154.88
Median
$245.47
Typical High
$446.68
Excellus BCBS
Setting
Facility
Modifier
Global
Typical Low
$239.88
Median
$239.88
Typical High
$251.19
Excellus BCBS
Setting
Professional
Modifier
Global
Typical Low
$239.88
Median
$257.04
Typical High
$275.42
MVP Health Care
Setting
Facility
Modifier
Global
Typical Low
$524.81
Median
$50,118.72
Typical High
$75,857.76
MVP Health Care
Setting
Professional
Modifier
Global
Typical Low
$186.21
Median
$223.87
Typical High
$354.81
United
Setting
Facility
Modifier
Global
Typical Low
$154.88
Median
$218.78
Typical High
$537.03
United
Setting
Professional
Modifier
Global
Typical Low
$134.90
Median
$223.87
Typical High
$398.11
Univera
Setting
Facility
Modifier
Global
Typical Low
$239.88
Median
$257.04
Typical High
$288.40
Univera
Setting
Professional
Modifier
Global
Typical Low
$239.88
Median
$257.04
Typical High
$275.42

Where New York 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 York· 8th of 51

$240

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.