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

Alabama 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 $204 · 10th–90th $115$3550%10%20%10th90th$204Professionalmedian $186 · 10th–90th $148$3240%20%10th90th$186$0.2$1.0$5.0$20.0$100.0$500.0

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
Professional
Modifier
Global
Typical Low
$158.49
Median
$204.17
Typical High
$323.59
BCBS
Setting
Professional
Modifier
Global
Typical Low
$257.04
Median
$257.04
Typical High
$257.04
Cigna
Setting
Facility
Modifier
Global
Typical Low
$229.09
Median
$229.09
Typical High
$229.09
Cigna
Setting
Professional
Modifier
Global
Typical Low
$165.96
Median
$165.96
Typical High
$398.11
United
Setting
Facility
Modifier
Global
Typical Low
$114.82
Median
$181.97
Typical High
$354.81
United
Setting
Professional
Modifier
Global
Typical Low
$102.33
Median
$151.36
Typical High
$239.88