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

North Dakota 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?

$331

Typical negotiated rate. In North Dakota, October 2026.

Insurers have agreed to pay about $331 for this service. The price depends on where it is billed: about $331 from a physician practice, and about $251 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 5 insurance carriers under federal price transparency rules.

Prices by location type

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$331$251 to $389
FacilityA hospital or hospital-owned outpatient department$251$251 to $251

How much rates vary

Facilitymedian $251 · 10th to 90th $229 to $759Professionalmedian $331 · 10th to 90th $151 to $398
$100$200$500$1Kfacility $251professional $331

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

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
None
Typical Low
$251.19
Median
$251.19
Typical High
$251.19
Aetna
Setting
Professional
Modifier
None
Typical Low
$181.97
Median
$251.19
Typical High
$251.19
BCBS North Dakota
Setting
Professional
Modifier
None
Typical Low
$288.40
Median
$389.05
Typical High
$389.05
BCBS North Dakota
Setting
Professional
Modifier
22 · Increased work
Typical Low
$346.74
Median
$467.74
Typical High
$467.74
Cigna
Setting
Facility
Modifier
None
Typical Low
$229.09
Median
$229.09
Typical High
$229.09
Cigna
Setting
Professional
Modifier
None
Typical Low
$229.09
Median
$398.11
Typical High
$489.78
Medica
Setting
Facility
Modifier
None
Typical Low
$158.49
Median
$251.19
Typical High
$1,584.89
Medica
Setting
Professional
Modifier
None
Typical Low
$138.04
Median
$169.82
Typical High
$281.84
United
Setting
Professional
Modifier
None
Typical Low
$120.23
Median
$169.82
Typical High
$275.42

Where North Dakota 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.

North Dakota· 8th of 51

$331

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.