go back

Louisiana 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
$185.18 / $196.57 / $264.81
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$162.72 / $196.57 / $213.67
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$298.22 / $509.47 / $716.13
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$203.38 / $243.27 / $243.27
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.00 / $40.00 / $40.00
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 / $227.96
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$101.26 / $159.40 / $234.07