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Massachusetts 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 $151 · 10th–90th $145–$1,6220%20%40%10th90th$151Professionalmedian $204 · 10th–90th $145–$3240%20%10th90th$204$0.2$2.0$20.0$200.0$2.0K$20.0K

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
Facility
Modifier
Typical Low / Median / Typical High
$144.54 / $144.54 / $144.54
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$134.90 / $169.82 / $309.03
AllWays Health Partners
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$275.42 / $323.59 / $1,621.81
AllWays Health Partners
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$138.04 / $257.04 / $371.54
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$229.09 / $229.09 / $245.47
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$165.96 / $165.96 / $234.42
Fallon Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$60.26 / $3,630.78 / $9,772.37
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$288.40 / $288.40 / $436.52
Health New England
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$245.47 / $245.47 / $245.47
Mass General Brigham
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$275.42 / $323.59 / $1,621.81
Mass General Brigham
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$138.04 / $257.04 / $371.54
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$97.72 / $177.83 / $416.87
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$138.04 / $234.42 / $295.12