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

Minnesota 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 $617 · 10th–90th $295$2,7540%20%10th90th$617Professionalmedian $339 · 10th–90th $214$3980%20%40%10th90th$339$0.5$2.0$10.0$50.0$200.0$1.0K$5.0K

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
$234.42
Median
$234.42
Typical High
$234.42
Aetna
Setting
Professional
Modifier
Global
Typical Low
$128.82
Median
$213.80
Typical High
$251.19
BCBS
Setting
Facility
Modifier
Global
Typical Low
$331.13
Median
$338.84
Typical High
$501.19
BCBS
Setting
Professional
Modifier
Global
Typical Low
$275.42
Median
$338.84
Typical High
$338.84
Cigna
Setting
Facility
Modifier
Global
Typical Low
$831.76
Median
$1,288.25
Typical High
$3,548.13
Cigna
Setting
Professional
Modifier
Global
Typical Low
$398.11
Median
$446.68
Typical High
$501.19
Health Partners
Setting
Facility
Modifier
Global
Typical Low
$977.24
Median
$1,412.54
Typical High
$2,754.23
Health Partners
Setting
Professional
Modifier
Global
Typical Low
$398.11
Median
$398.11
Typical High
$537.03
Medica
Setting
Facility
Modifier
Global
Typical Low
$147.91
Median
$338.84
Typical High
$1,584.89
Medica
Setting
Professional
Modifier
Global
Typical Low
$102.33
Median
$151.36
Typical High
$407.38
United
Setting
Facility
Modifier
Global
Typical Low
$2.45
Median
$151.36
Typical High
$501.19
United
Setting
Professional
Modifier
Global
Typical Low
$112.20
Median
$177.83
Typical High
$478.63