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Iowa 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 $339 · 10th–90th $174–$9770%20%10th90th$339Professionalmedian $182 · 10th–90th $141–$3720%20%10th90th$182$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
$213.80 / $213.80 / $251.19
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$134.90 / $181.97 / $302.00
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$229.09 / $229.09 / $380.19
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$229.09 / $398.11 / $489.78
Hally Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$288.40 / $398.11 / $426.58
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$234.42 / $407.38 / $1,584.89
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$151.36 / $204.17 / $562.34
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$371.54 / $389.05 / $467.74
Midlands
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$380.19 / $380.19 / $380.19
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$346.74 / $562.34 / $562.34
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$117.49 / $346.74 / $812.83
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$151.36 / $169.82 / $323.59
Wellmark
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$263.03 / $331.13 / $331.13