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Georgia 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 $347 · 10th–90th $162–$1,2880%10%20%10th90th$347Professionalmedian $191 · 10th–90th $151–$3550%20%40%10th90th$191$0.2$1.0$5.0$20.0$100.0$500.0$2.0K

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
$162.18 / $416.87 / $758.58
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$144.54 / $173.78 / $302.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$346.74 / $831.76 / $1,288.25
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$186.21 / $281.84 / $478.63
CareSource
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$288.40 / $288.40 / $288.40
CareSource
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$288.40 / $288.40 / $288.40
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$229.09 / $229.09 / $229.09
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$165.96 / $165.96 / $416.87
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$245.47 / $346.74 / $478.63
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$95.50 / $151.36 / $281.84
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$114.82 / $162.18 / $331.13