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

Michigan 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 October 2026.

How much does TLSO, Sagittal-Coronal Control, One-Piece Rigid Shell cost?

$269

Typical negotiated rate. In Michigan, October 2026.

Insurers have agreed to pay about $269 for this service. The price depends on where it is billed: about $269 from a physician practice, and about $575 from a hospital or other facility.

These are rates insurers have negotiated with providers, not the amount a patient is billed. What you owe depends on your plan's deductible and coinsurance. Based on rates published by 7 insurance carriers under federal price transparency rules.

Prices by location type

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$269$195 to $339
FacilityA hospital or hospital-owned outpatient department$575$229 to $1,000

How much rates vary

Facilitymedian $575 · 10th to 90th $229 to $1,514Professionalmedian $269 · 10th to 90th $158 to $347
$200$500$1K$2Kfacility $575professional $269

Distribution of negotiated rates across all payers (price axis is log-scale). Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
None
Typical Low
$199.53
Median
$338.84
Typical High
$338.84
Aetna
Setting
Professional
Modifier
None
Typical Low
$199.53
Median
$199.53
Typical High
$338.84
BCBS Michigan
Setting
Facility
Modifier
None
Typical Low
$407.38
Median
$1,000.00
Typical High
$1,905.46
BCBS Michigan
Setting
Professional
Modifier
None
Typical Low
$323.59
Median
$338.84
Typical High
$338.84
CareSource
Setting
Facility
Modifier
None
Typical Low
$223.87
Median
$223.87
Typical High
$223.87
Cigna
Setting
Facility
Modifier
None
Typical Low
$229.09
Median
$229.09
Typical High
$229.09
Cigna
Setting
Professional
Modifier
None
Typical Low
$165.96
Median
$229.09
Typical High
$380.19
Health Alliance Plan
Setting
Facility
Modifier
None
Typical Low
$194.98
Median
$660.69
Typical High
$724.44
Health Alliance Plan
Setting
Professional
Modifier
None
Typical Low
$194.98
Median
$269.15
Typical High
$346.74
Priority Health
Setting
Facility
Modifier
None
Typical Low
$229.09
Median
$229.09
Typical High
$229.09
Priority Health
Setting
Professional
Modifier
None
Typical Low
$165.96
Median
$229.09
Typical High
$338.84
United
Setting
Facility
Modifier
None
Typical Low
$354.81
Median
$416.87
Typical High
$501.19
United
Setting
Professional
Modifier
None
Typical Low
$125.89
Median
$158.49
Typical High
$234.42
1 more rate with less common billing modifiers

A modifier changes what was billed, for example a reduced or repeated service. Each of these modifiers carries under 10% of the published rates for this code. Modifier combinations, and modifiers with fewer than 30 rates for a carrier, are not listed.

Insurance Carrier
BCBS Michigan
Setting
Professional
Modifier
RR · Rental
Typical Low
$338.84
Median
$338.84
Typical High
$338.84

Where Michigan sits

The same service costs 4.8 times more in Kansas than in New Jersey. Every bar is a state, most expensive first. Touch or drag across it to read any state, then open that state for its carriers and full range.

Michigan· 15th of 51

$269

KS $794NJ $166

Median negotiated rate in each state, from every insurer that publishes one. States where no insurer publishes a rate for this service are not shown.