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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
$175.18 / $177.55 / $224.78
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$145.36 / $182.86 / $258.02
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$332.68 / $356.11 / $665.36
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$185.44 / $185.44 / $278.95
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$227.96 / $227.96 / $227.96
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$166.41 / $215.74 / $234.80
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.72 / $165.97 / $255.18