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

Nebraska 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 $347 · 10th–90th $151$1,5850%10%20%10th90th$347Professionalmedian $158 · 10th–90th $129$2820%20%40%10th90th$158$100.0$200.0$500.0$1.0K$2.0K

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
$218.78
Median
$218.78
Typical High
$218.78
Aetna
Setting
Professional
Modifier
Global
Typical Low
$128.82
Median
$158.49
Typical High
$218.78
BCBS
Setting
Professional
Modifier
Global
Typical Low
$295.12
Median
$331.13
Typical High
$331.13
Cigna
Setting
Facility
Modifier
Global
Typical Low
$229.09
Median
$229.09
Typical High
$380.19
Cigna
Setting
Professional
Modifier
Global
Typical Low
$229.09
Median
$398.11
Typical High
$707.95
Medica
Setting
Facility
Modifier
Global
Typical Low
$218.78
Median
$371.54
Typical High
$1,584.89
Medica
Setting
Professional
Modifier
Global
Typical Low
$112.20
Median
$169.82
Typical High
$338.84
Midlands
Setting
Professional
Modifier
Global
Typical Low
$371.54
Median
$371.54
Typical High
$912.01
Midlands
Setting
Facility
Modifier
Global
Typical Low
$380.19
Median
$380.19
Typical High
$380.19
Midlands
Setting
Professional
Modifier
Global
Typical Low
$467.74
Median
$851.14
Typical High
$912.01
United
Setting
Facility
Modifier
Global
Typical Low
$138.04
Median
$346.74
Typical High
$354.81
United
Setting
Professional
Modifier
Global
Typical Low
$117.49
Median
$169.82
Typical High
$263.03