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

North Carolina 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 $302 · 10th–90th $145$6610%10%20%10th90th$302Professionalmedian $263 · 10th–90th $155$3020%50%10th90th$263$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
$302.00
Median
$302.00
Typical High
$302.00
Aetna
Setting
Professional
Modifier
Global
Typical Low
$147.91
Median
$302.00
Typical High
$302.00
BCBS
Setting
Facility
Modifier
Global
Typical Low
$323.59
Median
$512.86
Typical High
$676.08
BCBS
Setting
Professional
Modifier
Global
Typical Low
$263.03
Median
$263.03
Typical High
$288.40
Cigna
Setting
Facility
Modifier
Global
Typical Low
$229.09
Median
$229.09
Typical High
$257.04
Cigna
Setting
Professional
Modifier
Global
Typical Low
$165.96
Median
$165.96
Typical High
$234.42
Medcost
Setting
Professional
Modifier
Global
Typical Low
$158.49
Median
$169.82
Typical High
$223.87
Medcost
Setting
Facility
Modifier
Global
Typical Low
$141.25
Median
$302.00
Typical High
$501.19
United
Setting
Facility
Modifier
Global
Typical Low
$117.49
Median
$281.84
Typical High
$346.74
United
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$169.82
Typical High
$234.42
Wellcare
Setting
Facility
Modifier
Global
Typical Low
$1,621.81
Median
$1,621.81
Typical High
$1,621.81
Wellcare
Setting
Professional
Modifier
Global
Typical Low
$2,511.89
Median
$4,365.16
Typical High
$4,365.16