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TLSO, Sagittal-Coronal Control, One-Piece Rigid Shell

Nationwide rates for HCPCS L0490

Thoracic-lumbar-sacral orthosis (TLSO), sagittal-coronal control, one-piece rigid plastic shell, with overlapping reinforced anterior, with multiple straps and closures, posterior extends from sacrococcygeal junction and terminates at or before the T-9 vertebra, anterior extends from symphysis pubis to xiphoid, anterior opening, restricts gross trunk motion in sagittal and coronal planes, prefabricated, includes fitting and adjustment

Rates data updated July 2026.

Facilitymedian $257 · 10th–90th $145$7940%20%10th90th$257Professionalmedian $186 · 10th–90th $141$3980%20%40%10th90th$186$0.2$2.0$20.0$200.0$2.0K$20.0K$200.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$138.04
Median
$177.83
Typical High
$323.59
Aetna
Setting
Professional
Modifier
Global
Typical Low
$134.90
Median
$173.78
Typical High
$302.00
BCBS
Setting
Facility
Modifier
Global
Typical Low
$138.04
Median
$190.55
Typical High
$676.08
BCBS
Setting
Professional
Modifier
Global
Typical Low
$177.83
Median
$186.21
Typical High
$416.87
Cigna
Setting
Facility
Modifier
Global
Typical Low
$229.09
Median
$229.09
Typical High
$1,288.25
Cigna
Setting
Professional
Modifier
Global
Typical Low
$165.96
Median
$165.96
Typical High
$489.78
United
Setting
Facility
Modifier
Global
Typical Low
$117.49
Median
$218.78
Typical High
$416.87
United
Setting
Professional
Modifier
Global
Typical Low
$120.23
Median
$169.82
Typical High
$309.03