Hospitals report these codes with terse, inconsistent chargemaster text. This plain-English title was written by an AI model from that text and has not been reviewed by a person, so it can be wrong. The prices on this page come straight from hospital filings and do not depend on it.
Original text from hospital filings
TLSO, TRIPLANAR CONTROL, MODULAR SEGMENTED SPINAL SYSTEM, FOUR RIGID PLASTIC SHELLS, POSTERIOR EXTENDS FROM SACROCOCCYGEAL JUNCTION AND TERMINATES JUST INFERIOR TO SCAPULAR SPINE, ANTERIOR EXTENDS FROM SYMPHYSIS PUBIS TO THE STERNAL NOTCH, SOFT LINER, RES
Low
$181
Average
$3.4k
Median
$1.8k
High
$21.3k
Each hospital's average Tricare rate, under the methodology and billing class chosen below.
84 hospitals; the 90th percentile is 8.0× the 10th. Each bar is a price range and its height is how many hospitals fall in it. Hover a bar, or a row in the ladder, for details.
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85 hospital rates
iThe hospitals that file a Tricare rate for this code, one row per hospital and set of terms (billing class, payment method, setting). Rates under different terms are never blended, so the terms are shown under each hospital’s name. Figures are the hospital’s averages across its plans.| # | Plans | |||||||
|---|---|---|---|---|---|---|---|---|
| 1 | Affinity Hospital LLC Birmingham, AL facility · fee schedule · outpatient | 1 | $1.7k | $1.7k | — | — | — | $1.7k – $1.7k |
| 2 | Beaufort Memorial Hospital Beaufort, SC facility · fee schedule · outpatient | 1 | $1.8k | $1.8k | — | — | — | $1.8k – $1.8k |
| 3 | Butler Healthcare Providers_ DBA Butler Memorial Hospital Butler, PA facility · fee schedule · outpatient | 1 | $1.7k | $1.7k | — | — | — | $1.7k – $1.7k |
| 4 | CORNING HOSPITAL Corning, NY facility · other · outpatient | 2 | $6.2k | $6.2k | — | — | — | $6.2k – $6.2k |
| 5 | Canton-Potsdam Hospital Potsdam, NY facility · fee schedule · outpatient | 1 | $1.6k | $1.6k | — | — | — | $1.6k – $1.6k |
| 6 | CentraState Medical Center Freehold Township, NJ other · outpatient | 2 | $21.3k | $21.3k | — | — | — | $21.3k – $21.3k |
| 7 | Central Maine Medical Center Lewiston, ME fee schedule · outpatient | 1 | $1.8k | $1.8k | — | — | — | $1.8k – $1.8k |
| 8 | Charleston Area Medical Center Charleston, WV percent of total billed charges · bothfrom % of charges | 1 | $5.0k | $5.0k | — | — | — | $5.0k – $5.0k |
| 9 | Chilton Medical Center Pompton Plains, NJ other · outpatient | 2 | $21.3k | $21.3k | — | — | — | $21.3k – $21.3k |
| 10 | Clarion Hospital Clarion, PA facility · fee schedule · outpatient | 1 | $1.7k | $1.7k | — | — | — | $1.7k – $1.7k |
| 11 | Eisenhower Medical Center Rancho Mirage, CA fee schedule · both | 3 | $1.8k | $1.8k | — | — | — | $1.8k – $1.8k |
| 12 | FORT LOUDOUN MEDICAL CENTER Lenoir City, TN fee schedule · both | 1 | $1.8k | $1.8k | — | — | — | $1.8k – $1.8k |
| 13 | FORT SANDERS REGIONAL MEDICAL CENTER Knoxville, TN fee schedule · both | 1 | $1.8k | $1.8k | — | — | — | $1.8k – $1.8k |
| 14 | GUTHRIE CORTLAND MEDICAL CENTER Cortland, NY facility · other · outpatient | 1 | $3.5k | $3.5k | — | — | — | $3.5k – $3.5k |
| 15 | Garfield County, a political subdivision of the State of Utah, DBA Intermountain Health Garfield Memorial Hospital Panguitch, UT facility · percent of total billed charges · inpatientfrom % of charges | 1 | $515 | $515 | — | — | — | $515 – $515 |
| 16 | Garfield County, a political subdivision of the State of Utah, DBA Intermountain Health Garfield Memorial Hospital Panguitch, UT facility · percent of total billed charges · outpatientfrom % of charges | 1 | $433 | $433 | — | — | — | $433 – $433 |
| 17 | HMA Santa Rosa Medical Center LLC Milton, FL facility · fee schedule · outpatient | 1 | $305 | $305 | — | — | — | $305 – $305 |
| 18 | Hackettstown Medical Center Hackettstown, NJ other · outpatient | 2 | $21.3k | $21.3k | — | — | — | $21.3k – $21.3k |
| 19 | Holy Cross Germantown Hospital Germantown, MD facility · percent of total billed charges · bothfrom % of charges | 1 | $607 | $607 | — | — | — | $607 – $607 |
| 20 | Holy Cross Hospital-Silver Spring Silver Spring, MD facility · percent of total billed charges · bothfrom % of charges | 1 | $505 | $505 | — | — | — | $505 – $505 |
| 21 | Hospital Authority of Colquitt County Moultrie, GA fee schedule · both | 1 | $766 | $766 | $23 | 3% | — | $743 – $789 |
| 22 | Hospital Service District #1, Parish of Terrebonne, State of Louisiana dba Terrebonne General Health System Houma, LA facility · fee schedule · outpatient | 1 | $1.8k | $1.8k | — | — | — | $1.8k – $1.8k |
| 23 | IHC Health Services Inc., DBA Intermountain Primary Children's Hospital City, UT facility · fee schedule · outpatient | 1 | $1.8k | $1.8k | — | — | — | $1.8k – $1.8k |
| 24 | IHC Health Services Inc., DBA Intermountain Primary Children's Hospital Lehi, UT facility · fee schedule · outpatient | 1 | $1.8k | $1.8k | — | — | — | $1.8k – $1.8k |
| 25 | Little Company of Mary Hospital of Indiana Inc Jasper, IN facility · case rate · outpatient | 1 | $1.8k | $1.8k | — | — | — | $1.8k – $1.8k |
← Payers reporting HCPCS L0464 · Snapshot 20261111T120946Z-9134e7f7