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Nationwide 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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$134.90 / $177.83 / $380.19
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$141.25 / $177.83 / $302.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$138.04 / $190.55 / $676.08
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$177.83 / $186.21 / $416.87
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$229.09 / $229.09 / $1,380.38
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$165.96 / $165.96 / $489.78
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$114.82 / $181.97 / $416.87
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$117.49 / $165.96 / $263.03