go back

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

Kentucky 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 $151$9550%20%10th90th$182Professionalmedian $178 · 10th–90th $158$2690%50%10th90th$178$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
$177.83
Median
$177.83
Typical High
$181.97
Aetna
Setting
Professional
Modifier
Global
Typical Low
$154.88
Median
$181.97
Typical High
$323.59
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$316.23
Median
$346.74
Typical High
$371.54
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$158.49
Median
$177.83
Typical High
$186.21
CareSource
Setting
Facility
Modifier
Global
Typical Low
$257.04
Median
$467.74
Typical High
$602.56
CareSource
Setting
Professional
Modifier
Global
Typical Low
$338.84
Median
$426.58
Typical High
$549.54
Cigna
Setting
Facility
Modifier
Global
Typical Low
$229.09
Median
$954.99
Typical High
$954.99
Cigna
Setting
Professional
Modifier
Global
Typical Low
$165.96
Median
$234.42
Typical High
$1,659.59
Molina
Setting
Professional
Modifier
Global
Typical Low
$177.83
Median
$223.87
Typical High
$288.40
United
Setting
Facility
Modifier
Global
Typical Low
$102.33
Median
$151.36
Typical High
$190.55
United
Setting
Professional
Modifier
Global
Typical Low
$112.20
Median
$165.96
Typical High
$223.87