go back

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

Vermont 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 $191 · 10th–90th $115$2450%20%40%10th90th$191Professionalmedian $166 · 10th–90th $162$2290%20%40%10th90th$166$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
$162.18
Median
$162.18
Typical High
$208.93
Cigna
Setting
Facility
Modifier
Global
Typical Low
$229.09
Median
$229.09
Typical High
$245.47
Cigna
Setting
Professional
Modifier
Global
Typical Low
$165.96
Median
$165.96
Typical High
$229.09
MVP Health Care
Setting
Professional
Modifier
Global
Typical Low
$263.03
Median
$263.03
Typical High
$323.59
United
Setting
Facility
Modifier
Global
Typical Low
$114.82
Median
$151.36
Typical High
$190.55
United
Setting
Professional
Modifier
Global
Typical Low
$120.23
Median
$234.42
Typical High
$676.08