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

Florida 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 $182 · 10th–90th $148$6460%20%10th90th$182Professionalmedian $174 · 10th–90th $141$3020%20%10th90th$174$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
$147.91
Median
$165.96
Typical High
$181.97
Aetna
Setting
Professional
Modifier
Global
Typical Low
$141.25
Median
$173.78
Typical High
$302.00
AvMed
Setting
Facility
Modifier
Global
Typical Low
$346.74
Median
$346.74
Typical High
$346.74
AvMed
Setting
Professional
Modifier
Global
Typical Low
$257.04
Median
$323.59
Typical High
$346.74
Cigna
Setting
Facility
Modifier
Global
Typical Low
$229.09
Median
$229.09
Typical High
$954.99
Cigna
Setting
Professional
Modifier
Global
Typical Low
$165.96
Median
$165.96
Typical High
$229.09
Florida Blue
Setting
Facility
Modifier
Global
Typical Low
$645.65
Median
$645.65
Typical High
$645.65
Florida Blue
Setting
Professional
Modifier
Global
Typical Low
$77.62
Median
$208.93
Typical High
$912.01
Molina
Setting
Professional
Modifier
Global
Typical Low
$512.86
Median
$794.33
Typical High
$912.01
United
Setting
Facility
Modifier
Global
Typical Low
$120.23
Median
$162.18
Typical High
$346.74
United
Setting
Professional
Modifier
Global
Typical Low
$134.90
Median
$165.96
Typical High
$229.09
Wellpoint
Setting
Professional
Modifier
Global
Typical Low
$346.74
Median
$794.33
Typical High
$794.33