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

Nevada 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 $115 · 10th–90th $115$3390%50%90th$115Professionalmedian $141 · 10th–90th $115$4790%10%20%10th90th$141$5.0$20.0$100.0$500.0

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
$114.82
Median
$114.82
Typical High
$114.82
Aetna
Setting
Professional
Modifier
Global
Typical Low
$114.82
Median
$134.90
Typical High
$1,445.44
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$338.84
Median
$338.84
Typical High
$354.81
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$186.21
Median
$186.21
Typical High
$186.21
Cigna
Setting
Facility
Modifier
Global
Typical Low
$162.18
Median
$229.09
Typical High
$263.03
Cigna
Setting
Professional
Modifier
Global
Typical Low
$151.36
Median
$165.96
Typical High
$229.09
Hometown Health
Setting
Professional
Modifier
Global
Typical Low
$190.55
Median
$338.84
Typical High
$575.44
Select Health
Setting
Facility
Modifier
Global
Typical Low
$338.84
Median
$338.84
Typical High
$338.84
Select Health
Setting
Professional
Modifier
Global
Typical Low
$213.80
Median
$302.00
Typical High
$338.84
United
Setting
Facility
Modifier
Global
Typical Low
$114.82
Median
$151.36
Typical High
$190.55
United
Setting
Professional
Modifier
Global
Typical Low
$138.04
Median
$218.78
Typical High
$389.05