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

South Dakota 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 October 2026.

How much does TLSO, Sagittal-Coronal Control, One-Piece Rigid Shell cost?

$339

Typical negotiated rate. In South Dakota, October 2026.

Insurers have agreed to pay about $339 for this service. The price depends on where it is billed: about $339 from a physician practice, and about $380 from a hospital or other facility.

These are rates insurers have negotiated with providers, not the amount a patient is billed. What you owe depends on your plan's deductible and coinsurance. Based on rates published by 7 insurance carriers under federal price transparency rules.

Prices by location type

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$339$229 to $372
FacilityA hospital or hospital-owned outpatient department$380$251 to $398

How much rates vary

Facilitymedian $380 · 10th to 90th $234 to $646Professionalmedian $339 · 10th to 90th $138 to $457
$200$500$1K$2Kfacility $380professional $339

Distribution of negotiated rates across all payers (price axis is log-scale). Small sample; interpret with caution. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
None
Typical Low
$251.19
Median
$251.19
Typical High
$251.19
Aetna
Setting
Professional
Modifier
None
Typical Low
$234.42
Median
$234.42
Typical High
$251.19
Cigna
Setting
Facility
Modifier
None
Typical Low
$229.09
Median
$229.09
Typical High
$380.19
Cigna
Setting
Professional
Modifier
None
Typical Low
$371.54
Median
$398.11
Typical High
$489.78
Medica
Setting
Facility
Modifier
None
Typical Low
$234.42
Median
$398.11
Typical High
$645.65
Medica
Setting
Professional
Modifier
None
Typical Low
$138.04
Median
$218.78
Typical High
$4,168.69
Midlands
Setting
Professional
Modifier
None
Typical Low
$371.54
Median
$371.54
Typical High
$371.54
Midlands
Setting
Facility
Modifier
None
Typical Low
$380.19
Median
$380.19
Typical High
$380.19
Midlands
Setting
Professional
Modifier
None
Typical Low
$309.03
Median
$309.03
Typical High
$616.60
Sanford Health Plan
Setting
Professional
Modifier
None
Typical Low
$295.12
Median
$346.74
Typical High
$398.11
United
Setting
Professional
Modifier
None
Typical Low
$125.89
Median
$169.82
Typical High
$269.15
Wellmark
Setting
Professional
Modifier
None
Typical Low
$338.84
Median
$338.84
Typical High
$338.84

Where South Dakota sits

The same service costs 4.8 times more in Kansas than in New Jersey. Every bar is a state, most expensive first. Touch or drag across it to read any state, then open that state for its carriers and full range.

South Dakota· 6th of 51

$339

KS $794NJ $166

Median negotiated rate in each state, from every insurer that publishes one. States where no insurer publishes a rate for this service are not shown.