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Montana 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 $339 · 10th–90th $224–$4170%20%10th90th$339Professionalmedian $200 · 10th–90th $112–$4170%10%10th90th$200$100.0$200.0$500.0$1.0K

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
Professional
Modifier
Typical Low / Median / Typical High
$112.20 / $190.55 / $288.40
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$229.09 / $363.08 / $363.08
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$229.09 / $363.08 / $363.08
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$263.03 / $338.84 / $660.69
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$263.03 / $338.84 / $660.69
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$162.18 / $316.23 / $416.87
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$79.43 / $269.15 / $363.08
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$151.36 / $173.78 / $190.55
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$138.04 / $151.36 / $234.42