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Alaska 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
Professional
Modifier
Low / Median / High Price
$284.99 / $284.99 / $284.99
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 / $227.96 / $234.80
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$98.06 / $98.06 / $98.06
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$316.05 / $316.05 / $499.02
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$98.06 / $98.06 / $227.96
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$166.41 / $234.80 / $327.93
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$160.79 / $318.11 / $414.93