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Indiana 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
$168.69 / $168.69 / $340.82
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$162.19 / $171.87 / $183.06
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$269.25 / $305.02 / $340.82
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$166.26 / $185.44 / $255.90
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$257.00 / $374.90 / $511.23
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$289.70 / $374.90 / $460.11
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$227.96 / $227.96 / $340.82
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$166.41 / $227.96 / $349.62
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$101.26 / $162.94 / $228.86