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

Arkansas 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 $398,107 · 10th–90th $191$891,2510%10%20%10th90th$398,107Professionalmedian $166 · 10th–90th $102$2040%50%10th90th$166$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
$190.55
Median
$190.55
Typical High
$190.55
Aetna
Setting
Professional
Modifier
Global
Typical Low
$97.72
Median
$186.21
Typical High
$204.17
BCBS
Setting
Facility
Modifier
Global
Typical Low
$218,776.16
Median
$524,807.46
Typical High
$954,992.59
BCBS
Setting
Professional
Modifier
Global
Typical Low
$295.12
Median
$295.12
Typical High
$389.05
Cigna
Setting
Facility
Modifier
Global
Typical Low
$229.09
Median
$229.09
Typical High
$380.19
Cigna
Setting
Professional
Modifier
Global
Typical Low
$128.82
Median
$165.96
Typical High
$229.09
United
Setting
Facility
Modifier
Global
Typical Low
$117.49
Median
$173.78
Typical High
$416.87
United
Setting
Professional
Modifier
Global
Typical Low
$102.33
Median
$154.88
Typical High
$229.09