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 TRIPLAN 2PC W/LINER
Arlington, TX
See all hospitals reporting HCPCS L0486 →Price type
AMH Cath Labs LLC’s median price of $3.4k is 35% above the median hospital's median price ($2.5k), higher than 72% of the 1,091 hospitals reporting HCPCS L0486. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.
Negotiated rates from the hospital’s own file: 9 payers, 31 plan rates. A facility fee, a professional fee, a per diem and a case rate are different bills, so each is listed on its own. Open a payer to see it across hospitals.
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| # | |||||||
|---|---|---|---|---|---|---|---|
| 1 | Blue Cross Blue Shield managed medicaid percent of total billed charges · outpatientfrom % of charges | $572 | $572 | — | — | — | $572 – $572 |
| 2 | UnitedHealthcare managed medicaid percent of total billed charges · outpatientfrom % of charges | $572 | $572 | — | — | — | $572 – $572 |
| 3 | WellCare managed medicaid percent of total billed charges · outpatientfrom % of charges | $601 | $601 | — | — | — | $601 – $601 |
| 4 | Molina managed medicaid percent of total billed charges · outpatientfrom % of charges | $618 | $618 | — | — | — | $618 – $618 |
| 5 | Aetna managed medicaid percent of total billed charges · outpatientfrom % of charges | $630 | $630 | — | — | — | $630 – $630 |
| 6 | Blue Cross Blue Shield exchange percent of total billed charges · outpatientfrom % of charges | $2.0k | $2.0k | — | — | — | $2.0k – $2.0k |
| 7 | Blue Cross Blue Shield medicare advantage case rate · outpatient | $2.2k | $2.2k | — | — | — | $2.2k – $2.2k |
| 8 | Humana medicare advantage case rate · outpatient | $2.3k | $2.3k | — | — | — | $2.3k – $2.3k |
| 9 | Humana medicare advantage ppo case rate · outpatient | $2.3k | $2.3k | — | — | — | $2.3k – $2.3k |
| 10 | Molina medicare advantage case rate · outpatient | $2.3k | $2.3k | — | — | — | $2.3k – $2.3k |
| 11 | WellCare medicare advantage hmo case rate · outpatient | $2.3k | $2.3k | — | — | — | $2.3k – $2.3k |
| 12 | WellCare medicare advantage mmp case rate · outpatient | $2.4k | $2.4k | — | — | — | $2.4k – $2.4k |
| 13 | UnitedHealthcare medicare advantage ppo case rate · outpatient | $2.4k | $2.4k | — | — | — | $2.4k – $2.4k |
| 14 | UnitedHealthcare medicare advantage hmo case rate · outpatient | $2.5k | $2.5k | — | — | — | $2.5k – $2.5k |
| 15 | Aetna whole health percent of total billed charges · outpatientfrom % of charges | $2.6k | $2.6k | — | — | — | $2.6k – $2.6k |
| 16 | Blue Cross Blue Shield hmo percent of total billed charges · outpatientfrom % of charges | $3.2k | $3.2k | — | — | — | $3.2k – $3.2k |
| 17 | Aetna commercial percent of total billed charges · outpatientfrom % of charges | $3.5k | $3.5k | — | — | — | $3.5k – $3.5k |
| 18 | Cigna oap/hmo percent of total billed charges · outpatientfrom % of charges | $3.6k | $3.6k | — | — | — | $3.6k – $3.6k |
| 19 | Blue Cross Blue Shield ppo percent of total billed charges · outpatientfrom % of charges | $3.6k | $3.6k | — | — | — | $3.6k – $3.6k |
| 20 | Blue Cross Blue Shield traditional percent of total billed charges · outpatientfrom % of charges | $3.6k | $3.6k | — | — | — | $3.6k – $3.6k |
| 21 | UnitedHealthcare all payer percent of total billed charges · outpatientfrom % of charges | $4.1k | $4.1k | — | — | — | $4.1k – $4.1k |
| 22 | UnitedHealthcare ppo percent of total billed charges · outpatientfrom % of charges | $4.3k | $4.3k | — | — | — | $4.3k – $4.3k |
| 23 | Phcs ppo percent of total billed charges · outpatientfrom % of charges | $4.5k | $4.5k | — | — | — | $4.5k – $4.5k |
| 24 | Cigna ppo percent of total billed charges · outpatientfrom % of charges | $4.5k | $4.5k | — | — | — | $4.5k – $4.5k |
| 25 | Aetna asa percent of total billed charges · outpatientfrom % of charges | $4.5k | $4.5k | — | — | — | $4.5k – $4.5k |
Last updated: Apr 21, 2026
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