Thoracolumbosacral spinal orthosis with rigid plastic shells

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.

Model: claude-haiku-5-5
Provider: anthropic
API: message_batches
Reasoning effort: low
Max output tokens: 4096
Prompt version (hash): 444523875572
Generated: October 20, 2026

Original text from hospital filings

TLSO 3 piece rigid shell

Payers reporting HCPCS L0492

Payer pricing summary

Low

$165

Average

$717

Median

$631

High

$1.7k

Payer rate distribution

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#
1	Aetna fee schedule · outpatient · +9 other terms	358	$620	$710	$335	47%	—	$306 – $4.1k
2	UnitedHealthcare fee schedule · outpatient · +9 other terms	356	$618	$618	$145	23%	—	$268 – $2.0k
3	Humana fee schedule · outpatient · +9 other terms	317	$615	$918	$988	108%	—	$315 – $4.7k
4	Blue Cross Blue Shield fee schedule · outpatient · +7 other terms	217	$627	$809	$429	53%	—	$0 – $3.0k
5	WellCare fee schedule · outpatient · +4 other terms	208	$633	$650	$100	15%	—	$589 – $1.2k
6	Devoted fee schedule · outpatient · +3 other terms	165	$615	$616	$18	3%	—	$577 – $744
7	Molina fee schedule · outpatient · +4 other terms	138	$882	$849	$316	37%	—	$427 – $1.6k
8	Cigna Healthspring fee schedule · outpatient · +1 other terms	116	$630	$626	$23	4%	—	$601 – $751
9	Cigna fee schedule · outpatient · +6 other terms	102	$633	$699	$197	28%	—	$578 – $1.8k
10	Anthem fee schedule · outpatient · +6 other terms	81	$601	$835	$811	97%	—	$403 – $4.6k
11	Kaiser fee schedule · outpatient · +4 other terms	64	$613	$992	$708	71%	—	$578 – $4.4k
12	Superior Healthplan fee schedule · outpatient	40	$646	$645	$3	0%	—	$603 – $646
13	Clover fee schedule · outpatient · +2 other terms	37	$615	$622	$29	5%	—	$593 – $730
14	Oscar fee schedule · outpatient · +3 other terms	35	$646	$707	$159	23%	—	$603 – $1.1k
15	Ambetter facility · fee schedule · outpatient · +5 other terms	34	$1.1k	$1.2k	$267	23%	—	$594 – $1.5k
16	Optum fee schedule · outpatient · +2 other terms	33	$615	$798	$329	41%	—	$566 – $1.5k
17	Caresource fee schedule · outpatient · +4 other terms	28	$615	$664	$165	25%	—	$403 – $950
18	Medica facility · fee schedule · outpatient · +5 other terms	22	$628	$574	$146	25%	—	$205 – $962
19	Regence facility · fee schedule · outpatient · +3 other terms	19	$625	$606	$38	6%	—	$505 – $637
20	Amerihealth Caritas fee schedule · outpatient · +1 other terms	18	$738	$719	$38	5%	—	$618 – $738
21	Bcbs Tx fee schedule · outpatient	18	$603	$603	—	—	—	$603 – $603
22	Medicare fee schedule · outpatient · +1 other terms	18	$578	$580	$4	1%	—	$578 – $590
23	Medical Mutual facility · fee schedule · outpatient · +1 other terms	15	$615	$708	$175	25%	—	$335 – $971
24	Bcbs Mn fee schedule · outpatient · +6 other terms	13	$559	$559	$130	23%	—	$272 – $655
25	Wellmark fee schedule · both · +1 other terms	13	$555	$552	$17	3%	—	$447 – $555

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