go back

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

New Jersey 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 $112 · 10th–90th $112$3390%50%90th$112Professionalmedian $166 · 10th–90th $129$3310%10%10th90th$166$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
$112.20
Median
$112.20
Typical High
$112.20
Aetna
Setting
Professional
Modifier
Global
Typical Low
$112.20
Median
$151.36
Typical High
$213.80
Cigna
Setting
Facility
Modifier
Global
Typical Low
$208.93
Median
$229.09
Typical High
$338.84
Cigna
Setting
Professional
Modifier
Global
Typical Low
$165.96
Median
$165.96
Typical High
$229.09
Emblem Health
Setting
Professional
Modifier
Global
Typical Low
$218.78
Median
$323.59
Typical High
$446.68
Horizon BCBS
Setting
Professional
Modifier
Global
Typical Low
$331.13
Median
$331.13
Typical High
$331.13
United
Setting
Facility
Modifier
Global
Typical Low
$128.82
Median
$338.84
Typical High
$338.84
United
Setting
Professional
Modifier
Global
Typical Low
$147.91
Median
$177.83
Typical High
$323.59