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

Maryland 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 $174 · 10th–90th $115$3390%10%10th90th$174Professionalmedian $162 · 10th–90th $135$2880%20%10th90th$162$100.0$200.0$500.0$1.0K

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
Professional
Modifier
Global
Typical Low
$134.90
Median
$144.54
Typical High
$269.15
CareFirst
Setting
Professional
Modifier
Global
Typical Low
$288.40
Median
$288.40
Typical High
$288.40
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
$229.09
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$239.88
Median
$338.84
Typical High
$512.86
United
Setting
Facility
Modifier
Global
Typical Low
$102.33
Median
$151.36
Typical High
$338.84
United
Setting
Professional
Modifier
Global
Typical Low
$141.25
Median
$169.82
Typical High
$269.15
Wellpoint
Setting
Professional
Modifier
Global
Typical Low
$181.97
Median
$181.97
Typical High
$288.40