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Missouri 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
$177.55 / $177.55 / $236.54
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$175.18 / $184.00 / $280.83
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$339.15 / $356.11 / $1,565.52
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$168.56 / $185.44 / $278.95
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 / $166.41 / $234.80
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$169.75 / $274.51 / $1,593.03
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.85 / $169.20 / $412.23
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$118.93 / $169.20 / $250.82