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

Illinois 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 $347 · 10th–90th $174$1,7380%20%10th90th$347Professionalmedian $178 · 10th–90th $158$3550%50%10th90th$178$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
$173.78
Median
$173.78
Typical High
$346.74
Aetna
Setting
Professional
Modifier
Global
Typical Low
$158.49
Median
$173.78
Typical High
$346.74
BCBS
Setting
Facility
Modifier
Global
Typical Low
$407.38
Median
$660.69
Typical High
$2,344.23
Cigna
Setting
Facility
Modifier
Global
Typical Low
$229.09
Median
$229.09
Typical High
$380.19
Cigna
Setting
Professional
Modifier
Global
Typical Low
$165.96
Median
$165.96
Typical High
$371.54
Hally Health
Setting
Professional
Modifier
Global
Typical Low
$288.40
Median
$426.58
Typical High
$512.86
Hally Health
Setting
Facility
Modifier
Global
Typical Low
$100.00
Median
$100.00
Typical High
$100.00
Hally Health
Setting
Professional
Modifier
Global
Typical Low
$446.68
Median
$446.68
Typical High
$446.68
Molina
Setting
Professional
Modifier
Global
Typical Low
$177.83
Median
$177.83
Typical High
$257.04
United
Setting
Facility
Modifier
Global
Typical Low
$151.36
Median
$275.42
Typical High
$346.74
United
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$169.82
Typical High
$288.40