HCPCS L0484
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
Current code23 hospitals with prices
What Washington hospitals publish for this code
Medicare Advantage: Rate for a private Medicare Advantage plan. Applies only to members of that plan.
| Hospital | Medicare Advantage rates (lowest – highest) | Cash price | List price (before discounts) |
|---|---|---|---|
| Capital Medical Center | $2,001 – $2,201 | $1,041 | $2,603 |
| Deaconess Medical Center | $2,001 – $2,201 | $1,041 | $2,603 |
| Harborview Medical Center | $2,042 – $2,246 | $2,502 | $3,574 |
| Kadlec Regional Medical Center | $2,042 – $2,451 | — | — |
| Mary Bridge Children's Hospital | $2,001 – $2,201 | $1,041 | $2,603 |
| MultiCare Auburn Medical Center | $2,001 – $2,201 | $1,041 | $2,603 |
| MultiCare Covington Medical Center | $2,001 – $2,201 | $1,041 | $2,603 |
| MultiCare Good Samaritan Hospital | $2,001 – $2,201 | $1,041 | $2,603 |
| MultiCare Valley Hospital | $2,061 – $2,201 | $1,041 | $2,603 |
| Overlake Hospital Medical Center & Clinics | $2,042 – $2,124 | — | — |
| Prov Sacred HRT Med Ctr & Childs Hosp. | $2,042 – $2,451 | — | — |
| Providence Centralia Hospital | $2,042 – $3,267 | — | — |
| Providence Regional Medical Center Everett | $2,042 – $2,246 | — | — |
| Providence St Peter Hospital | $2,042 – $3,267 | — | — |
| Swedish Edmonds Hospital | $2,042 – $2,451 | — | — |
| Swedish Issaquah | $2,042 – $2,451 | $3,907 | $8,139 |
| Swedish Medical Center | $2,042 – $2,451 | $3,907 | $8,139 |
| Swedish Medical Center / Cherry Hill | $2,042 – $2,451 | $3,907 | $8,139 |
| Tacoma General Allenmore Hospital | $2,001 – $2,201 | $1,041 | $2,603 |
| University of Washington Medical Ctr | $2,042 – $2,246 | $3,321 | $4,744 |
| Virginia Mason Medical Center | $1,401 – $2,102 | — | — |
| Wellfound Behavioral Health Hospital | — | — | — |
| Yakima Valley Memorial | $2,001 – $2,241 | $1,041 | $2,603 |
Medicare (traditional) reference
Only for people on original Medicare. These are CMS’s 2026 amounts. They aren’t what private insurance or cash patients pay.
- Equipment fee, Washington
- $2,042 (fee)