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

Tennessee 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 $269 · 10th–90th $151$1,6220%20%10th90th$269Professionalmedian $166 · 10th–90th $151$2880%20%40%10th90th$166$0.2$1.0$5.0$20.0$100.0$500.0$2.0K

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
$154.88
Median
$169.82
Typical High
$269.15
Aetna
Setting
Professional
Modifier
Global
Typical Low
$151.36
Median
$162.18
Typical High
$288.40
BCBS
Setting
Professional
Modifier
Global
Typical Low
$263.03
Median
$263.03
Typical High
$269.15
Cigna
Setting
Facility
Modifier
Global
Typical Low
$229.09
Median
$229.09
Typical High
$263.03
Cigna
Setting
Professional
Modifier
Global
Typical Low
$165.96
Median
$165.96
Typical High
$229.09
Lucent Health
Setting
Facility
Modifier
Global
Typical Low
$1,621.81
Median
$1,621.81
Typical High
$1,621.81
Lucent Health
Setting
Professional
Modifier
Global
Typical Low
$2,511.89
Median
$2,511.89
Typical High
$4,365.16
United
Setting
Facility
Modifier
Global
Typical Low
$117.49
Median
$177.83
Typical High
$346.74
United
Setting
Professional
Modifier
Global
Typical Low
$114.82
Median
$162.18
Typical High
$223.87