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TLSO, Triplanar Control, Two Rigid Shells, Prefabricated

Arizona rates for HCPCS L0458

Thoracic-lumbar-sacral orthosis (TLSO), triplanar control, modular segmented spinal system, two rigid plastic shells, posterior extends from the sacrococcygeal junction and terminates just inferior to the scapular spine, anterior extends from the symphysis pubis to the xiphoid, soft liner, restricts gross trunk motion in the sagittal, coronal, and transverse planes, lateral strength is provided by overlapping plastic and stabilizing closures, includes straps and closures, prefabricated, includes fitting and adjustment

Rates data updated July 2026.

How much does TLSO, Triplanar Control, Two Rigid Shells, Prefabricated cost?

$562

Typical negotiated rate. In Arizona, July 2026.

Insurers have agreed to pay about $562 for this service. The price depends on where it is billed: about $562 from a physician practice, and about $891 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$562$447 to $676
FacilityA hospital or hospital-owned outpatient department$891$457 to $1,413

How much rates vary

Facilitymedian $891 · 10th to 90th $309 to $2,188Professionalmedian $562 · 10th to 90th $417 to $1,122
$1.0$10.0$100.0$1.0Kfacility $891professional $562

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
Professional
Modifier
Global
Typical Low
$416.87
Median
$562.34
Typical High
$707.95
BCBS
Setting
Facility
Modifier
Global
Typical Low
$295.12
Median
$1,174.90
Typical High
$2,290.87
BCBS
Setting
Professional
Modifier
Global
Typical Low
$812.83
Median
$1,096.48
Typical High
$2,187.76
Cigna
Setting
Facility
Modifier
Global
Typical Low
$691.83
Median
$691.83
Typical High
$691.83
Cigna
Setting
Professional
Modifier
Global
Typical Low
$512.86
Median
$512.86
Typical High
$691.83
Medica
Setting
Facility
Modifier
Global
Typical Low
$309.03
Median
$776.25
Typical High
$5,011.87
Medica
Setting
Professional
Modifier
Global
Typical Low
$380.19
Median
$478.63
Typical High
$5,370.32
United
Setting
Facility
Modifier
Global
Typical Low
$371.54
Median
$851.14
Typical High
$1,071.52
United
Setting
Professional
Modifier
Global
Typical Low
$371.54
Median
$478.63
Typical High
$724.44

Where Arizona sits

The same service costs 2.5 times more in Minnesota than in Washington, DC. Every bar is a state, most expensive first. Pick one to see its carriers and full range.

Arizona $562 · 37th of 51
MN $1,072DC $427

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.