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

Mississippi 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 $263 · 10th–90th $170$4170%20%40%10th90th$263Professionalmedian $195 · 10th–90th $151$3240%10%20%10th90th$195$50.0$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
Facility
Modifier
Global
Typical Low
$204.17
Median
$204.17
Typical High
$309.03
Aetna
Setting
Professional
Modifier
Global
Typical Low
$151.36
Median
$204.17
Typical High
$323.59
BCBS
Setting
Facility
Modifier
Global
Typical Low
$263.03
Median
$263.03
Typical High
$263.03
BCBS
Setting
Professional
Modifier
Global
Typical Low
$263.03
Median
$263.03
Typical High
$263.03
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
$229.09
Molina
Setting
Professional
Modifier
Global
Typical Low
$30.20
Median
$30.20
Typical High
$281.84
United
Setting
Facility
Modifier
Global
Typical Low
$102.33
Median
$281.84
Typical High
$501.19
United
Setting
Professional
Modifier
Global
Typical Low
$102.33
Median
$162.18
Typical High
$234.42