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

Louisiana 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 $182$6170%20%10th90th$282Professionalmedian $186 · 10th–90th $141$2510%20%40%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
$194.98
Aetna
Setting
Professional
Modifier
Global
Typical Low
$151.36
Median
$186.21
Typical High
$263.03
BCBS
Setting
Facility
Modifier
Global
Typical Low
$295.12
Median
$512.86
Typical High
$707.95
BCBS
Setting
Professional
Modifier
Global
Typical Low
$245.47
Median
$245.47
Typical High
$245.47
Christus
Setting
Facility
Modifier
Global
Typical Low
$39.81
Median
$39.81
Typical High
$39.81
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
$331.13
United
Setting
Facility
Modifier
Global
Typical Low
$114.82
Median
$281.84
Typical High
$416.87
United
Setting
Professional
Modifier
Global
Typical Low
$102.33
Median
$162.18
Typical High
$229.09