TLSO, Triplanar Control, Four Rigid Shells, Prefabricated
Arizona rates for HCPCS L0464
Thoracic-lumbar-sacral orthosis (TLSO), triplanar control, modular segmented spinal system, four rigid plastic shells, posterior extends from sacrococcygeal junction and terminates just inferior to scapular spine, anterior extends from symphysis pubis to the sternal notch, soft liner, restricts gross trunk motion in 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, Four Rigid Shells, Prefabricated cost?
$955
Typical negotiated rate. In Arizona, July 2026.
Insurers have agreed to pay about $955 for this service. The price depends on where it is billed: about $955 from a physician practice, and about $1,514 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 by
Who charges it
Typical
Range
Physician practiceA doctor's office, clinic or independent provider
A doctor's office, clinic or independent provider
$955
$759 to $1,122
FacilityA hospital or hospital-owned outpatient department
A hospital or hospital-owned outpatient department
$1,514
$776 to $2,344
How much rates vary
Facilitymedian $1,514 · 10th to 90th $513 to $3,631Professionalmedian $955 · 10th to 90th $692 to $1,622
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
Facility/Professional
Modifier
Typical LowTypical Low is the 10th percentile of the published rates, Median the 50th, and Typical High the 90th. One in ten rates falls below Typical Low, and one in ten falls above Typical High.
MedianTypical Low is the 10th percentile of the published rates, Median the 50th, and Typical High the 90th. One in ten rates falls below Typical Low, and one in ten falls above Typical High.
Typical HighTypical Low is the 10th percentile of the published rates, Median the 50th, and Typical High the 90th. One in ten rates falls below Typical Low, and one in ten falls above Typical High.
Aetna
Setting
Professional
Modifier
Global
Typical Low
$691.83
Median
$954.99
Typical High
$1,174.90
Professional
Global
$691.83
$954.99
$1,174.90
BCBS
Setting
Facility
Modifier
Global
Typical Low
$489.78
Median
$1,949.84
Typical High
$3,801.89
Facility
Global
$489.78
$1,949.84
$3,801.89
BCBS
Setting
Professional
Modifier
Global
Typical Low
$1,348.96
Median
$1,819.70
Typical High
$3,630.78
Professional
Global
$1,348.96
$1,819.70
$3,630.78
Cigna
Setting
Facility
Modifier
Global
Typical Low
$1,174.90
Median
$1,174.90
Typical High
$1,174.90
Facility
Global
$1,174.90
$1,174.90
$1,174.90
Cigna
Setting
Professional
Modifier
Global
Typical Low
$851.14
Median
$851.14
Typical High
$1,174.90
Professional
Global
$851.14
$851.14
$1,174.90
Medica
Setting
Facility
Modifier
Global
Typical Low
$512.86
Median
$1,288.25
Typical High
$8,317.64
Facility
Global
$512.86
$1,288.25
$8,317.64
Medica
Setting
Professional
Modifier
Global
Typical Low
$630.96
Median
$794.33
Typical High
$9,120.11
Professional
Global
$630.96
$794.33
$9,120.11
United
Setting
Facility
Modifier
Global
Typical Low
$616.60
Median
$1,412.54
Typical High
$1,778.28
Facility
Global
$616.60
$1,412.54
$1,778.28
United
Setting
Professional
Modifier
Global
Typical Low
$616.60
Median
$794.33
Typical High
$1,202.26
Professional
Global
$616.60
$794.33
$1,202.26
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. Touch or drag across it to read any state, then open that state for its carriers and full range.