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

Arizona 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 $269 · 10th–90th $98$6760%10%10th90th$269Professionalmedian $178 · 10th–90th $132$3310%20%10th90th$178$0.2$1.0$5.0$20.0$100.0$500.0$2.0K

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
Professional
Modifier
Global
Typical Low
$131.83
Median
$181.97
Typical High
$223.87
BCBS
Setting
Facility
Modifier
Global
Typical Low
$85.11
Median
$346.74
Typical High
$660.69
BCBS
Setting
Professional
Modifier
Global
Typical Low
$239.88
Median
$323.59
Typical High
$645.65
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
$229.09
Medica
Setting
Facility
Modifier
Global
Typical Low
$97.72
Median
$245.47
Typical High
$1,584.89
Medica
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$151.36
Typical High
$4,168.69
United
Setting
Facility
Modifier
Global
Typical Low
$117.49
Median
$269.15
Typical High
$338.84
United
Setting
Professional
Modifier
Global
Typical Low
$117.49
Median
$151.36
Typical High
$229.09