go back

Connecticut 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
$161.69 / $161.69 / $161.69
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$144.78 / $159.01 / $162.72
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$257.83 / $332.68 / $380.62
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$185.44 / $185.44 / $194.29
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 / $227.96
ConnectiCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$216.24 / $216.24 / $216.24
ConnectiCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$216.24 / $216.24 / $306.07
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$245.63 / $245.63 / $245.63
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$126.66 / $165.97 / $320.38