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Kansas 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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$280.83 / $280.83 / $280.83
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$98.06 / $184.00 / $280.83
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$997.69 / $1,039.80 / $1,106.07
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$987.81 / $987.81 / $987.81
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$227.96 / $227.96 / $227.96
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$166.41 / $227.96 / $494.06
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$98.06 / $273.33 / $1,593.03
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$101.26 / $169.20 / $433.28
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$101.26 / $163.56 / $226.61