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Michigan 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 $417 · 10th–90th $191–$1,3800%10%20%10th90th$417Professionalmedian $182 · 10th–90th $145–$3390%20%40%10th90th$182$0.2$1.0$5.0$20.0$100.0$500.0$2.0K

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
$194.98 / $194.98 / $194.98
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$144.54 / $181.97 / $234.42
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$446.68 / $1,023.29 / $1,949.84
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$338.84 / $338.84 / $354.81
CareSource
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$223.87 / $223.87 / $223.87
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$229.09 / $229.09 / $229.09
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$165.96 / $229.09 / $380.19
Health Alliance Plan
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$194.98 / $645.65 / $724.44
Health Alliance Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$173.78 / $275.42 / $416.87
Priority Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$229.09 / $229.09 / $229.09
Priority Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$165.96 / $234.42 / $338.84
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$117.49 / $275.42 / $416.87
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$120.23 / $158.49 / $239.88