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Florida 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 $166 · 10th–90th $145–$2820%20%40%10th90th$166Professionalmedian $170 · 10th–90th $141–$3020%20%40%10th90th$170$0.2$1.0$5.0$20.0$100.0$500.0

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
Facility
Modifier
Typical Low / Median / Typical High
$144.54 / $158.49 / $181.97
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$141.25 / $177.83 / $302.00
AvMed
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$346.74 / $346.74 / $346.74
AvMed
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$257.04 / $323.59 / $346.74
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$229.09 / $229.09 / $954.99
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$165.96 / $165.96 / $229.09
Florida Blue
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$512.86 / $512.86 / $741.31
Florida Blue
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$77.62 / $208.93 / $912.01
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$512.86 / $794.33 / $977.24
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$117.49 / $151.36 / $416.87
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$134.90 / $165.96 / $218.78
Wellpoint
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$346.74 / $794.33 / $794.33