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

Colorado 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 $98$4680%20%10th90th$257Professionalmedian $186 · 10th–90th $145$2570%50%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
Facility
Modifier
Global
Typical Low
$194.98
Median
$194.98
Typical High
$338.84
Aetna
Setting
Professional
Modifier
Global
Typical Low
$144.54
Median
$194.98
Typical High
$257.04
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$354.81
Median
$426.58
Typical High
$758.58
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$165.96
Median
$186.21
Typical High
$323.59
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
$316.23
Denver HMP
Setting
Facility
Modifier
Global
Typical Low
$97.72
Median
$263.03
Typical High
$436.52
Denver HMP
Setting
Professional
Modifier
Global
Typical Low
$97.72
Median
$97.72
Typical High
$97.72
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$208.93
Median
$354.81
Typical High
$630.96
Select Health
Setting
Facility
Modifier
Global
Typical Low
$371.54
Median
$645.65
Typical High
$741.31
Select Health
Setting
Professional
Modifier
Global
Typical Low
$245.47
Median
$354.81
Typical High
$436.52
United
Setting
Facility
Modifier
Global
Typical Low
$125.89
Median
$173.78
Typical High
$354.81
United
Setting
Professional
Modifier
Global
Typical Low
$138.04
Median
$151.36
Typical High
$229.09