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

New Mexico 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 $234 · 10th–90th $98$3550%10%10th90th$234Professionalmedian $182 · 10th–90th $132$5130%10%10th90th$182$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
$169.82
Median
$169.82
Typical High
$169.82
Aetna
Setting
Professional
Modifier
Global
Typical Low
$131.83
Median
$181.97
Typical High
$1,445.44
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
$501.19
Molina
Setting
Professional
Modifier
Global
Typical Low
$275.42
Median
$338.84
Typical High
$512.86
Providence
Setting
Facility
Modifier
Global
Typical Low
$97.72
Median
$245.47
Typical High
$346.74
Providence
Setting
Professional
Modifier
Global
Typical Low
$165.96
Median
$165.96
Typical High
$346.74
United
Setting
Facility
Modifier
Global
Typical Low
$138.04
Median
$162.18
Typical High
$416.87
United
Setting
Professional
Modifier
Global
Typical Low
$138.04
Median
$151.36
Typical High
$229.09