HCPCS L0484 at University of Washington Medical Ctr

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

University of Washington Medical Ctr, Seattle

Description from CMS's HCPCS Level II code file.

What University of Washington Medical Ctr publishes for this code: as an outpatient

University of Washington Medical Ctr’s prices for HCPCS L0484, as an outpatient
Who pays	Hospital’s fee (lowest – highest)	Doctor’s fee the hospital lists
Commercial insuranceInsurer rates	$3,267 – $6,4045 plans	—
Medicare AdvantageInsurer rates	$2,042 – $2,2465 plans	—
Cash pricePaying yourself, without insurance	$3,321	—
List priceBefore any discount; few people pay it	$4,744	—

Lowest and highest amounts University of Washington Medical Ctr lists for this code as an outpatient, including lines it lists for both settings or without saying which. Its price file is dated 2026-04-01. This is one line of a bill; most care brings several.

Bills to expect

The hospital’s fee is the price above. Doctors usually send their own bills. Their amounts here are what original Medicare allows in Seattle (King County) for 2026, and a private-plan estimate of 118% to 179% of that (the range found across studies of what insurers pay doctors). Those are estimates, not quotes.

Bills to expect for HCPCS L0484 at University of Washington Medical Ctr
Bill	What it’s for	Original Medicare allows	Private plan estimate
Hospital's feeThe hospital	The service	—	The price above

Original Medicare amounts are only for people on original Medicare. Your share depends on your plan’s deductible, copay and coinsurance.

Compare HCPCS L0484 at every Washington hospital, with Medicare’s reference amounts.