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

Kansas 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 $282 · 10th–90th $98$1,0470%20%10th90th$282Professionalmedian $794 · 10th–90th $162$7940%50%10th$794$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
Facility
Modifier
Global
Typical Low
$263.03
Median
$263.03
Typical High
$263.03
Aetna
Setting
Professional
Modifier
Global
Typical Low
$97.72
Median
$181.97
Typical High
$281.84
BCBS
Setting
Facility
Modifier
Global
Typical Low
$977.24
Median
$1,047.13
Typical High
$1,096.48
BCBS
Setting
Professional
Modifier
Global
Typical Low
$794.33
Median
$794.33
Typical High
$794.33
Cigna
Setting
Facility
Modifier
Global
Typical Low
$229.09
Median
$229.09
Typical High
$239.88
Cigna
Setting
Professional
Modifier
Global
Typical Low
$165.96
Median
$165.96
Typical High
$398.11
Medica
Setting
Facility
Modifier
Global
Typical Low
$97.72
Median
$234.42
Typical High
$1,584.89
Medica
Setting
Professional
Modifier
Global
Typical Low
$102.33
Median
$169.82
Typical High
$4,168.69
United
Setting
Facility
Modifier
Global
Typical Low
$128.82
Median
$275.42
Typical High
$346.74
United
Setting
Professional
Modifier
Global
Typical Low
$112.20
Median
$169.82
Typical High
$239.88