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TLSO, Triplanar Control, Two Rigid Shells, Prefabricated

Washington 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 October 2026.

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

$912

Typical negotiated rate. In Washington, October 2026.

Insurers have agreed to pay about $912 for this service. The price depends on where it is billed: about $912 from a physician practice, and about $1,023 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 10 insurance carriers under federal price transparency rules.

Prices by location type

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$912$708 to $1,288
FacilityA hospital or hospital-owned outpatient department$1,023$912 to $1,288

How much rates vary

Facilitymedian $1,023 · 10th to 90th $832 to $1,738Professionalmedian $912 · 10th to 90th $513 to $2,239
$500$1K$2K$5Kfacility $1,023professional $912

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

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
None
Typical Low
$707.95
Median
$707.95
Typical High
$707.95
Aetna
Setting
Professional
Modifier
None
Typical Low
$630.96
Median
$707.95
Typical High
$707.95
Asuris Northwest Health
Setting
Facility
Modifier
None
Typical Low
$812.83
Median
$1,023.29
Typical High
$1,096.48
Asuris Northwest Health
Setting
Professional
Modifier
None
Typical Low
$912.01
Median
$5,495.41
Typical High
$7,943.28
Cigna
Setting
Facility
Modifier
None
Typical Low
$691.83
Median
$691.83
Typical High
$776.25
Cigna
Setting
Professional
Modifier
None
Typical Low
$512.86
Median
$512.86
Typical High
$691.83
Kaiser Permanente
Setting
Facility
Modifier
None
Typical Low
$1,000.00
Median
$1,258.93
Typical High
$1,905.46
Kaiser Permanente
Setting
Professional
Modifier
None
Typical Low
$954.99
Median
$1,288.25
Typical High
$2,137.96
Molina
Setting
Professional
Modifier
None
Typical Low
$724.44
Median
$812.83
Typical High
$891.25
Pacific Source
Setting
Facility
Modifier
None
Typical Low
$831.76
Median
$1,023.29
Typical High
$1,096.48
Pacific Source
Setting
Professional
Modifier
None
Typical Low
$831.76
Median
$831.76
Typical High
$1,148.15
Premera BCBS
Setting
Facility
Modifier
None
Typical Low
$912.01
Median
$912.01
Typical High
$2,041.74
Premera BCBS
Setting
Facility
Modifier
NR · New when rented
Typical Low
$912.01
Median
$912.01
Typical High
$912.01
Premera BCBS
Setting
Professional
Modifier
None
Typical Low
$870.96
Median
$870.96
Typical High
$1,023.29
Premera BCBS
Setting
Professional
Modifier
NR · New when rented
Typical Low
$870.96
Median
$870.96
Typical High
$1,023.29
Regence BlueShield
Setting
Facility
Modifier
None
Typical Low
$1,023.29
Median
$1,023.29
Typical High
$1,023.29
Regence BlueShield
Setting
Professional
Modifier
None
Typical Low
$851.14
Median
$912.01
Typical High
$1,122.02
United
Setting
Facility
Modifier
None
Typical Low
$1,548.82
Median
$1,548.82
Typical High
$1,548.82
United
Setting
Professional
Modifier
None
Typical Low
$457.09
Median
$478.63
Typical High
$933.25
Wellpoint
Setting
Professional
Modifier
None
Typical Low
$562.34
Median
$741.31
Typical High
$1,621.81

Where Washington sits

The same service costs 2.2 times more in Hawaii than in Delaware. 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.

Washington· 11th of 51

$912

HI $1,122DE $513

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.