HCPCS L0490

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

Current code23 hospitals with prices

Description from CMS's HCPCS Level II code file.

What Washington hospitals publish for this code

Commercial insurance: Rate negotiated with a private insurer or employer plan, including exchange and public-option plans.

Prices for HCPCS L0490 by hospital
HospitalCommercial insurance rates (lowest – highest)Cash priceList price (before discounts)
Capital Medical CenterOlympiaFile dated 2026-08-27$292 – $2,26916 plans——
Deaconess Medical CenterSpokaneFile dated 2026-08-27$406 – $1,4129 plans——
Harborview Medical CenterSeattleFile dated 2026-04-01$543 – $6792 plans$416$594
Kadlec Regional Medical CenterRichlandFile dated 2026-04-01$512 – $9535 plans——
Mary Bridge Children's HospitalTacomaFile dated 2026-08-27$292 – $2,4907 plans——
MultiCare Auburn Medical CenterAuburnFile dated 2026-08-27$284 – $1,46617 plans——
MultiCare Covington Medical CenterCovingtonFile dated 2026-08-27$284 – $1,46617 plans——
MultiCare Good Samaritan HospitalPuyallupFile dated 2026-08-27$330 – $1,46612 plans——
MultiCare Valley HospitalSpokane ValleyFile dated 2026-08-27$325 – $1,40910 plans——
Overlake Hospital Medical Center & ClinicsBellevueFile dated 2026-04-01$311 – $93410 plans——
Prov Sacred HRT Med Ctr & Childs Hosp.SpokaneFile dated 2026-04-01$526 – $1,1269 plans——
Providence Centralia HospitalCentraliaFile dated 2026-04-01$573 – $1,2695 plans——
Providence Regional Medical Center EverettEverettFile dated 2026-04-01$407 – $7877 plans——
Providence St Peter HospitalOlympiaFile dated 2026-04-01$288 – $1,1088 plans——
Swedish Edmonds HospitalEdmondsFile dated 2026-04-01$509 – $1,2457 plans——
Swedish IssaquahIssaquahFile dated 2026-04-01$509 – $7537 plans——
Swedish Medical CenterSeattleFile dated 2026-04-01$509 – $1,2129 plans——
Swedish Medical Center / Cherry HillSeattleFile dated 2026-04-01$509 – $1,2129 plans——
Tacoma General Allenmore HospitalTacomaFile dated 2026-08-27$284 – $1,46617 plans——
University of Washington Medical CtrSeattleFile dated 2026-04-01$543 – $1,0645 plans$526$751
Virginia Mason Medical CenterSeattle$325 – $1,1807 plans——
Wellfound Behavioral Health HospitalTacomaFile dated 2026-08-27$8561 plan——
Yakima Valley MemorialYakimaFile dated 2026-08-27$292 – $88013 plans——

Lowest and highest amounts each hospital lists for this code as an outpatient, including lines it lists for both settings or without saying which. A doctor’s fee is shown separately when the hospital lists one with the code. “At least” means plans were counted in more than one group and some may be the same plan. This is one line of a bill; most care brings several.

Medicare (traditional) reference

Only for people on original Medicare. These are CMS’s 2026 amounts. They aren’t what private insurance or cash patients pay.

Equipment fee, Washington
$339 (fee)