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Indiana 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 $170–$4270%20%40%10th90th$347Professionalmedian $174 · 10th–90th $151–$2820%50%10th90th$174$0.2$1.0$5.0$20.0$100.0$500.0

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
$169.82 / $169.82 / $169.82
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$151.36 / $169.82 / $281.84
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$186.21 / $346.74 / $436.52
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$177.83 / $186.21 / $371.54
CareSource
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$338.84 / $446.68 / $512.86
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$229.09 / $229.09 / $346.74
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$165.96 / $165.96 / $295.12
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$117.49 / $190.55 / $275.42
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$102.33 / $169.82 / $245.47