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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

Facilitymedian $182 · 10th–90th $98–$3390%20%40%10th90th$182Professionalmedian $200 · 10th–90th $166–$4070%20%10th90th$200$100.0$200.0$500.0$1.0K

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
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$165.96 / $199.53 / $302.00
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$229.09 / $229.09 / $229.09
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$165.96 / $165.96 / $363.08
Moda Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$97.72 / $245.47 / $338.84
Moda Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$181.97 / $323.59 / $1,096.48
Premera BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$288.40 / $323.59 / $338.84
Premera BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$269.15 / $323.59 / $338.84
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$97.72 / $97.72 / $354.81
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$60.26 / $229.09 / $316.23
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$151.36 / $151.36 / $173.78
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$151.36 / $234.42 / $831.76