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

Connecticut 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 $229 · 10th–90th $126$3390%10%20%10th90th$229Professionalmedian $166 · 10th–90th $138$3240%10%20%10th90th$166$20.0$50.0$100.0$200.0$500.0$1.0K

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

Insurance Carrier
Aetna
Setting
Professional
Modifier
Global
Typical Low
$138.04
Median
$158.49
Typical High
$346.74
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$263.03
Median
$338.84
Typical High
$407.38
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$186.21
Median
$194.98
Typical High
$446.68
Cigna
Setting
Facility
Modifier
Global
Typical Low
$229.09
Median
$229.09
Typical High
$338.84
Cigna
Setting
Professional
Modifier
Global
Typical Low
$165.96
Median
$165.96
Typical High
$165.96
ConnectiCare
Setting
Facility
Modifier
Global
Typical Low
$213.80
Median
$213.80
Typical High
$213.80
ConnectiCare
Setting
Professional
Modifier
Global
Typical Low
$213.80
Median
$245.47
Typical High
$371.54
Health New England
Setting
Professional
Modifier
Global
Typical Low
$245.47
Median
$245.47
Typical High
$245.47
United
Setting
Facility
Modifier
Global
Typical Low
$114.82
Median
$151.36
Typical High
$199.53
United
Setting
Professional
Modifier
Global
Typical Low
$114.82
Median
$165.96
Typical High
$309.03