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

Rhode Island 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 $603 · 10th–90th $186$7760%20%10th90th$603Professionalmedian $174 · 10th–90th $145$2290%20%10th90th$174$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. Small sample; interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Professional
Modifier
Global
Typical Low
$144.54
Median
$162.18
Typical High
$199.53
BCBS
Setting
Facility
Modifier
Global
Typical Low
$489.78
Median
$660.69
Typical High
$776.25
BCBS
Setting
Professional
Modifier
Global
Typical Low
$147.91
Median
$173.78
Typical High
$295.12
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
United
Setting
Facility
Modifier
Global
Typical Low
$151.36
Median
$186.21
Typical High
$416.87
United
Setting
Professional
Modifier
Global
Typical Low
$138.04
Median
$177.83
Typical High
$275.42