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TLSO, Triplanar Control, Two-Piece Shell without Liner

Hawaii rates for HCPCS L0484

Thoracic-lumbar-sacral orthosis (TLSO), triplanar control, two-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, lateral strength is enhanced by overlapping plastic, restricts gross trunk motion in the sagittal, coronal, and transverse planes, includes a carved plaster or CAD-CAM model, custom fabricated

Rates data updated July 2026.

How much does TLSO, Triplanar Control, Two-Piece Shell without Liner cost?

$2,570

Typical negotiated rate. In Hawaii, July 2026.

Insurers have agreed to pay about $2,570 for this service. Most negotiated rates run $1,318 to $2,570.

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.

How much rates vary

Facilitymedian $1,318 · 10th to 90th $1,000 to $1,995Professionalmedian $2,570 · 10th to 90th $724 to $2,692
$1K$2Kfacility $1,318professional $2,570

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. Small sample; interpret with caution. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Professional
Modifier
Global
Typical Low
$724.44
Median
$724.44
Typical High
$1,122.02
Cigna
Setting
Facility
Modifier
Global
Typical Low
$1,318.26
Median
$1,318.26
Typical High
$1,995.26
Cigna
Setting
Professional
Modifier
Global
Typical Low
$1,318.26
Median
$2,344.23
Typical High
$3,162.28
HMSA
Setting
Professional
Modifier
Global
Typical Low
$2,570.40
Median
$2,570.40
Typical High
$2,691.53
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$1,513.56
Median
$2,570.40
Typical High
$3,548.13
United
Setting
Facility
Modifier
Global
Typical Low
$1,000.00
Median
$1,258.93
Typical High
$1,318.26
United
Setting
Professional
Modifier
Global
Typical Low
$1,174.90
Median
$1,659.59
Typical High
$3,090.30

Where Hawaii sits

The same service costs 3.2 times more in Hawaii 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.

Hawaii· 1st of 51

$2,570

HI $2,570DC $813

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.