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Mississippi 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
$192.03 / $192.03 / $306.05
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$182.86 / $219.04 / $306.05
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$265.54 / $265.54 / $265.54
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$265.54 / $265.54 / $265.54
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 / $227.96
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$101.26 / $162.68 / $255.18