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Georgia rates for HCPCS L0490

Tlso Sagittal-Coronal Control One Piece Rigid Plastic Shell With Overlapping Reinforced Anterior With Multiple Straps And Closures Posterior Extends From Scarococcygeal Junction And Terminates At Or Before The T-9 Vertebra Anterior Extends Fromsymphysis 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
$162.72 / $386.55 / $766.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$154.16 / $182.86 / $258.02
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$342.66 / $479.72 / $1,257.56
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$182.69 / $284.92 / $651.90
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$282.77 / $291.26 / $633.91
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$291.26 / $291.26 / $291.26
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 / $215.74 / $395.25
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$260.42 / $342.66 / $476.04
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$423.64 / $582.52 / $646.59
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$113.97 / $170.95 / $282.05