go back

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.

Facilitymedian $240 · 10th–90th $145$4170%20%10th90th$240Professionalmedian $240 · 10th–90th $141$4370%20%10th90th$240$0.5$5.0$50.0$500.0$5.0K$50.0K

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
$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