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Colorado 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
$192.94 / $192.94 / $192.94
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$144.78 / $192.94 / $258.02
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$344.54 / $387.13 / $702.86
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$185.44 / $185.44 / $200.28
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 / $166.41 / $362.90
Denver HMP
Facility/Professional
Facility
Modifier
Low / Median / High Price
$98.06 / $192.94 / $433.43
Denver HMP
Facility/Professional
Professional
Modifier
Low / Median / High Price
$98.06 / $98.06 / $98.06
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$251.51 / $430.68 / $682.19
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$137.91 / $151.90 / $228.81