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

Oregon 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 $324 · 10th–90th $251$3390%50%10th90th$324Professionalmedian $245 · 10th–90th $145$3720%10%20%10th90th$245$0.2$2.0$20.0$200.0$2.0K$20.0K

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
Professional
Modifier
Global
Typical Low
$138.04
Median
$181.97
Typical High
$234.42
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
$165.96
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$257.04
Median
$676.08
Typical High
$812.83
Moda Health
Setting
Facility
Modifier
Global
Typical Low
$199.53
Median
$257.04
Typical High
$338.84
Moda Health
Setting
Professional
Modifier
Global
Typical Low
$251.19
Median
$263.03
Typical High
$363.08
Pacific Source
Setting
Facility
Modifier
Global
Typical Low
$263.03
Median
$323.59
Typical High
$338.84
Pacific Source
Setting
Professional
Modifier
Global
Typical Low
$331.13
Median
$331.13
Typical High
$346.74
Providence
Setting
Facility
Modifier
Global
Typical Low
$194.98
Median
$275.42
Typical High
$398.11
Providence
Setting
Professional
Modifier
Global
Typical Low
$79.43
Median
$288.40
Typical High
$354.81
Regence BlueShield
Setting
Facility
Modifier
Global
Typical Low
$275.42
Median
$346.74
Typical High
$1,318.26
Regence BlueShield
Setting
Professional
Modifier
Global
Typical Low
$316.23
Median
$371.54
Typical High
$371.54
United
Setting
Facility
Modifier
Global
Typical Low
$0.24
Median
$151.36
Typical High
$501.19
United
Setting
Professional
Modifier
Global
Typical Low
$120.23
Median
$151.36
Typical High
$288.40