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TLSO, One-Piece Shell without Liner, Custom Fabricated

Pennsylvania rates for HCPCS L0480

Thoracic-lumbar-sacral orthosis (TLSO), triplanar control, one-piece rigid plastic shell without interface liner, with multiple straps and closures, posterior extends from sacrococcygeal junction and terminates just inferior to scapular spine, anterior extends from symphysis pubis to sternal notch, anterior or posterior opening, restricts gross trunk motion in sagittal, coronal, and transverse planes, includes a carved plaster or CAD-CAM model, custom fabricated

Rates data updated July 2026.

How much does TLSO, One-Piece Shell without Liner, Custom Fabricated cost?

$794

Typical negotiated rate. In Pennsylvania, July 2026.

Insurers have agreed to pay about $794 for this service. The price depends on where it is billed: about $794 from a physician practice, and about $2,188 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 10 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$794$724 to $1,148
FacilityA hospital or hospital-owned outpatient department$2,188$661 to $3,467

How much rates vary

Facilitymedian $2,188 · 10th to 90th $661 to $7,762Professionalmedian $794 · 10th to 90th $661 to $1,622
$1K$2K$5K$10K$20K$50Kfacility $2,188professional $794

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
$660.69
Median
$660.69
Typical High
$2,570.40
Aetna
Setting
Professional
Modifier
Global
Typical Low
$660.69
Median
$794.33
Typical High
$1,318.26
Capital Blue Cross
Setting
Facility
Modifier
Global
Typical Low
$5,011.87
Median
$8,511.38
Typical High
$77,624.71
Capital Blue Cross
Setting
Professional
Modifier
Global
Typical Low
$1,621.81
Median
$1,621.81
Typical High
$1,621.81
Cigna
Setting
Facility
Modifier
Global
Typical Low
$1,023.29
Median
$1,023.29
Typical High
$2,511.89
Cigna
Setting
Professional
Modifier
Global
Typical Low
$741.31
Median
$741.31
Typical High
$1,023.29
Emblem Health
Setting
Professional
Modifier
Global
Typical Low
$1,819.70
Median
$2,570.40
Typical High
$3,715.35
Geisinger
Setting
Facility
Modifier
Global
Typical Low
$1,621.81
Median
$1,621.81
Typical High
$1,621.81
Geisinger
Setting
Professional
Modifier
Global
Typical Low
$977.24
Median
$1,148.15
Typical High
$1,621.81
Highmark BCBS
Setting
Professional
Modifier
Global
Typical Low
$1,202.26
Median
$1,202.26
Typical High
$1,202.26
Martin's Point
Setting
Facility
Modifier
Global
Typical Low
$660.69
Median
$660.69
Typical High
$2,570.40
Martin's Point
Setting
Professional
Modifier
Global
Typical Low
$660.69
Median
$794.33
Typical High
$1,737.80
Oscar Health
Setting
Facility
Modifier
Global
Typical Low
$1,023.29
Median
$1,023.29
Typical High
$1,023.29
Oscar Health
Setting
Professional
Modifier
Global
Typical Low
$1,778.28
Median
$1,778.28
Typical High
$1,778.28
UPMC Health Plan
Setting
Facility
Modifier
Global
Typical Low
$1,513.56
Median
$5,754.40
Typical High
$9,332.54
UPMC Health Plan
Setting
Professional
Modifier
Global
Typical Low
$1,148.15
Median
$1,513.56
Typical High
$1,862.09
United
Setting
Facility
Modifier
Global
Typical Low
$741.31
Median
$2,187.76
Typical High
$2,187.76
United
Setting
Professional
Modifier
Global
Typical Low
$630.96
Median
$794.33
Typical High
$1,778.28

Where Pennsylvania sits

The same service costs 3.1 times more in Kansas 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.

Pennsylvania· 48th of 51

$794

KS $2,042DC $661

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.