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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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$141.97 / $157.34 / $180.26
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$136.16 / $165.62 / $300.05
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
Florida Blue
Facility/Professional
Facility
Modifier
Low / Median / High Price
$514.19 / $99,999.99 / $99,999.99
Florida Blue
Facility/Professional
Professional
Modifier
Low / Median / High Price
$154.51 / $342.66 / $918.20
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$512.31 / $788.18 / $866.99
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$133.85 / $167.39 / $217.91
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$342.66 / $788.18 / $788.18