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Washington, DC 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
$136.16 / $136.16 / $136.16
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$136.16 / $136.16 / $136.16
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$291.31 / $291.31 / $291.31
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$166.41 / $166.41 / $166.41
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$216.24 / $216.24 / $660.38
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$110.65 / $165.97 / $249.37