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

Massachusetts 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 $257 · 10th–90th $145$1,6220%20%10th90th$257Professionalmedian $288 · 10th–90th $145$4470%20%10th90th$288$0.2$2.0$20.0$200.0$2.0K$20.0K

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
$144.54
Median
$144.54
Typical High
$144.54
Aetna
Setting
Professional
Modifier
Global
Typical Low
$144.54
Median
$162.18
Typical High
$512.86
AllWays Health Partners
Setting
Facility
Modifier
Global
Typical Low
$316.23
Median
$323.59
Typical High
$1,621.81
AllWays Health Partners
Setting
Professional
Modifier
Global
Typical Low
$138.04
Median
$257.04
Typical High
$407.38
Cigna
Setting
Facility
Modifier
Global
Typical Low
$229.09
Median
$229.09
Typical High
$245.47
Cigna
Setting
Professional
Modifier
Global
Typical Low
$165.96
Median
$165.96
Typical High
$234.42
Fallon Health
Setting
Facility
Modifier
Global
Typical Low
$60.26
Median
$3,630.78
Typical High
$9,772.37
Harvard Pilgrim
Setting
Professional
Modifier
Global
Typical Low
$288.40
Median
$288.40
Typical High
$436.52
Health New England
Setting
Professional
Modifier
Global
Typical Low
$245.47
Median
$245.47
Typical High
$245.47
Mass General Brigham
Setting
Facility
Modifier
Global
Typical Low
$316.23
Median
$323.59
Typical High
$1,621.81
Mass General Brigham
Setting
Professional
Modifier
Global
Typical Low
$138.04
Median
$257.04
Typical High
$407.38
United
Setting
Facility
Modifier
Global
Typical Low
$114.82
Median
$181.97
Typical High
$416.87
United
Setting
Professional
Modifier
Global
Typical Low
$138.04
Median
$281.84
Typical High
$316.23