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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

Facilitymedian $275 · 10th–90th $178–$6920%20%10th90th$275Professionalmedian $182 · 10th–90th $145–$3160%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
$177.83 / $177.83 / $204.17
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$144.54 / $177.83 / $288.40
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$346.74 / $346.74 / $1,202.26
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$177.83 / $186.21 / $331.13
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$208.93 / $208.93 / $346.74
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$229.09 / $229.09 / $239.88
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$165.96 / $165.96 / $229.09
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$169.82 / $269.15 / $1,584.89
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$117.49 / $169.82 / $4,168.69
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$141.25 / $275.42 / $275.42
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$120.23 / $162.18 / $263.03