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TLSO, Triplanar Control, Two-Piece Shell without Liner

North Dakota 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?

$2,188

Typical negotiated rate. In North Dakota, July 2026.

Insurers have agreed to pay about $2,188 for this service. The price depends on where it is billed: about $2,239 from a physician practice, and about $1,738 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 byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$2,239$1,738 to $2,692
FacilityA hospital or hospital-owned outpatient department$1,738$1,514 to $1,738

How much rates vary

Facilitymedian $1,738 · 10th to 90th $1,514 to $3,236Professionalmedian $2,239 · 10th to 90th $1,202 to $2,951
$1K$2K$5K$10Kfacility $1,738professional $2,239

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
$1,513.56
Median
$1,737.80
Typical High
$1,737.80
Aetna
Setting
Professional
Modifier
Global
Typical Low
$1,202.26
Median
$1,513.56
Typical High
$8,912.51
BCBS
Setting
Professional
Modifier
Global
Typical Low
$1,995.26
Median
$2,630.27
Typical High
$2,884.03
Cigna
Setting
Facility
Modifier
Global
Typical Low
$1,318.26
Median
$1,318.26
Typical High
$1,318.26
Cigna
Setting
Professional
Modifier
Global
Typical Low
$1,318.26
Median
$2,570.40
Typical High
$3,162.28
Medica
Setting
Facility
Modifier
Global
Typical Low
$933.25
Median
$1,862.09
Typical High
$10,471.29
Medica
Setting
Professional
Modifier
Global
Typical Low
$912.01
Median
$1,000.00
Typical High
$2,398.83
United
Setting
Facility
Modifier
Global
Typical Low
$1,000.00
Median
$1,000.00
Typical High
$3,235.94
United
Setting
Professional
Modifier
Global
Typical Low
$831.76
Median
$1,513.56
Typical High
$2,570.40

Where North Dakota 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.

North Dakota· 5th of 51

$2,188

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.