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Idaho 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 $324 · 10th–90th $174–$4170%20%40%10th90th$324Professionalmedian $224 · 10th–90th $135–$3720%10%10th90th$224$50.0$100.0$200.0$500.0$1.0K

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
Professional
Modifier
Typical Low / Median / Typical High
$134.90 / $199.53 / $288.40
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$263.03 / $323.59 / $549.54
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$354.81 / $371.54 / $371.54
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$208.93 / $229.09 / $239.88
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$165.96 / $165.96 / $229.09
Moda Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$97.72 / $323.59 / $371.54
Moda Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$199.53 / $302.00 / $338.84
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$30.20 / $30.20 / $288.40
Regence BlueShield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$316.23 / $323.59 / $323.59
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$239.88 / $239.88 / $354.81
Select Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$263.03 / $338.84 / $354.81
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$151.36 / $173.78 / $186.21
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$141.25 / $151.36 / $223.87