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TLSO, Triplanar Control, Hyperextension, Prefabricated

Pennsylvania 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 October 2026.

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

$295

Typical negotiated rate. In Pennsylvania, October 2026.

Insurers have agreed to pay about $295 for this service. The price depends on where it is billed: about $282 from a physician practice, and about $324 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$282$219 to $437
FacilityA hospital or hospital-owned outpatient department$324$295 to $1,479

How much rates vary

Facilitymedian $324 · 10th to 90th $295 to $2,570Professionalmedian $282 · 10th to 90th $186 to $457
$200$1K$5K$20Kfacility $324professional $282

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
$186.21
Median
$186.21
Typical High
$208.93
Aetna
Setting
Professional
Modifier
None
Typical Low
$186.21
Median
$208.93
Typical High
$218.78
Capital Blue Cross
Setting
Facility
Modifier
None
Typical Low
$4,265.80
Median
$5,011.87
Typical High
$79,432.82
Capital Blue Cross
Setting
Professional
Modifier
None
Typical Low
$363.08
Median
$457.09
Typical High
$457.09
Cigna
Setting
Facility
Modifier
None
Typical Low
$295.12
Median
$295.12
Typical High
$295.12
Cigna
Setting
Professional
Modifier
None
Typical Low
$218.78
Median
$218.78
Typical High
$2,570.40
Emblem Health
Setting
Professional
Modifier
None
Typical Low
$512.86
Median
$812.83
Typical High
$933.25
Geisinger
Setting
Facility
Modifier
None
Typical Low
$467.74
Median
$467.74
Typical High
$467.74
Geisinger
Setting
Professional
Modifier
None
Typical Low
$245.47
Median
$281.84
Typical High
$467.74
Highmark BCBS
Setting
Professional
Modifier
None
Typical Low
$338.84
Median
$338.84
Typical High
$338.84
Martin's Point
Setting
Facility
Modifier
None
Typical Low
$186.21
Median
$186.21
Typical High
$186.21
Martin's Point
Setting
Professional
Modifier
None
Typical Low
$186.21
Median
$208.93
Typical High
$218.78
Oscar Health
Setting
Professional
Modifier
None
Typical Low
$501.19
Median
$776.25
Typical High
$831.76
UPMC Health Plan
Setting
Facility
Modifier
None
Typical Low
$323.59
Median
$1,479.11
Typical High
$2,570.40
UPMC Health Plan
Setting
Professional
Modifier
None
Typical Low
$323.59
Median
$323.59
Typical High
$436.52
United
Setting
Facility
Modifier
None
Typical Low
$616.60
Median
$616.60
Typical High
$741.31
United
Setting
Professional
Modifier
None
Typical Low
$186.21
Median
$229.09
Typical High
$380.19

Where Pennsylvania sits

The same service costs 3.2 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.

Pennsylvania· 27th of 51

$295

HI $708DE $219

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.