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North Carolina 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
$300.05 / $300.05 / $517.62
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$146.30 / $300.05 / $300.05
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$312.14 / $508.30 / $625.98
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$238.56 / $257.00 / $282.70
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 / $227.96 / $395.25
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$98.06 / $300.05 / $676.00
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$192.00 / $192.00 / $233.00
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$399.20 / $399.20 / $613.79
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.72 / $169.43 / $247.88
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$535.41 / $1,593.03 / $1,593.03
Wellcare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,495.10 / $4,327.29 / $4,327.29