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TLSO, Triplanar Control, Hyperextension, Prefabricated

New Hampshire rates for HCPCS L0472

Thoracic-lumbar-sacral orthosis (TLSO), triplanar control, hyperextension, rigid anterior and lateral frame extends from symphysis pubis to sternal notch with two anterior components (one pubic and one sternal), posterior and lateral pads with straps and closures, limits spinal flexion, restricts gross trunk motion in sagittal, coronal, and transverse planes, includes fitting and shaping the frame, prefabricated, includes fitting and adjustment

Rates data updated July 2026.

How much does TLSO, Triplanar Control, Hyperextension, Prefabricated cost?

$363

Typical negotiated rate. In New Hampshire, July 2026.

Insurers have agreed to pay about $363 for this service. The price depends on where it is billed: about $331 from a physician practice, and about $550 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 6 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$331$275 to $479
FacilityA hospital or hospital-owned outpatient department$550$363 to $589

How much rates vary

Facilitymedian $550 · 10th to 90th $309 to $676Professionalmedian $331 · 10th to 90th $240 to $479
$200.0$500.0$1.0K$2.0Kfacility $550professional $331

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
$309.03
Median
$309.03
Typical High
$363.08
Aetna
Setting
Professional
Modifier
Global
Typical Low
$186.21
Median
$309.03
Typical High
$363.08
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$549.54
Median
$588.84
Typical High
$676.08
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$275.42
Median
$275.42
Typical High
$281.84
Cigna
Setting
Facility
Modifier
Global
Typical Low
$295.12
Median
$295.12
Typical High
$398.11
Cigna
Setting
Professional
Modifier
Global
Typical Low
$218.78
Median
$218.78
Typical High
$295.12
Harvard Pilgrim
Setting
Professional
Modifier
Global
Typical Low
$478.63
Median
$478.63
Typical High
$870.96
United
Setting
Facility
Modifier
Global
Typical Low
$141.25
Median
$223.87
Typical High
$281.84
United
Setting
Professional
Modifier
Global
Typical Low
$204.17
Median
$323.59
Typical High
$478.63
Well Sense
Setting
Facility
Modifier
Global
Typical Low
$524.81
Median
$524.81
Typical High
$676.08

Where New Hampshire sits

The same service costs 3.8 times more in Hawaii than in Washington, DC. Every bar is a state, most expensive first. Pick one to see its carriers and full range.

New Hampshire $363 · 13th of 51
HI $708DC $186

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.