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TLSO, Sagittal-Coronal Control, Modular, Three Shells

Montana rates for HCPCS L0492

Thoracic-lumbar-sacral orthosis (TLSO), sagittal-coronal control, modular segmented spinal system, three rigid plastic shells, posterior extends from the sacrococcygeal junction and terminates just inferior to the scapular spine, anterior extends from the symphysis pubis to the xiphoid, soft liner, restricts gross trunk motion in the sagittal and coronal planes, lateral strength is provided by overlapping plastic and stabilizing closures, includes straps and closures, prefabricated, includes fitting and adjustment

Rates data updated October 2026.

How much does TLSO, Sagittal-Coronal Control, Modular, Three Shells cost?

$617

Typical negotiated rate. In Montana, October 2026.

Insurers have agreed to pay about $617 for this service. The price depends on where it is billed: about $562 from a physician practice, and about $661 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 5 insurance carriers under federal price transparency rules.

Prices by location type

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$562$269 to $617
FacilityA hospital or hospital-owned outpatient department$661$603 to $33,884

How much rates vary

Facilitymedian $661 · 10th to 90th $457 to $35,481Professionalmedian $562 · 10th to 90th $79 to $661
$100$500$2K$10Kfacility $661professional $562

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

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Professional
Modifier
None
Typical Low
$173.78
Median
$316.23
Typical High
$562.34
Cigna
Setting
Facility
Modifier
None
Typical Low
$549.54
Median
$616.60
Typical High
$616.60
Cigna
Setting
Professional
Modifier
None
Typical Low
$501.19
Median
$616.60
Typical High
$616.60
MountainHealth Co-op
Setting
Facility
Modifier
None
Typical Low
$457.09
Median
$758.58
Typical High
$35,481.34
MountainHealth Co-op
Setting
Professional
Modifier
None
Typical Low
$602.56
Median
$660.69
Typical High
$36,307.81
Providence
Setting
Facility
Modifier
None
Typical Low
$331.13
Median
$616.60
Typical High
$616.60
Providence
Setting
Professional
Modifier
None
Typical Low
$79.43
Median
$467.74
Typical High
$616.60
United
Setting
Professional
Modifier
None
Typical Low
$245.47
Median
$269.15
Typical High
$446.68

Where Montana sits

The same service costs 2.4 times more in Hawaii than in Delaware. 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.

Montana· 2nd of 51

$617

HI $661DE $275

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.