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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

Facilitymedian $302 · 10th–90th $141–$6760%10%20%10th90th$302Professionalmedian $224 · 10th–90th $145–$3020%20%40%10th90th$224$0.2$2.0$20.0$200.0$2.0K$20.0K

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
$302.00 / $302.00 / $302.00
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$144.54 / $194.98 / $302.00
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$281.84 / $281.84 / $338.84
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$263.03 / $263.03 / $281.84
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$229.09 / $229.09 / $257.04
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$165.96 / $165.96 / $245.47
Medcost
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$158.49 / $169.82 / $223.87
Medcost
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$141.25 / $302.00 / $501.19
Oscar Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.60 / $0.60 / $0.60
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$102.33 / $151.36 / $281.84
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $169.82 / $239.88
Wellcare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,621.81 / $1,621.81 / $1,621.81
Wellcare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,511.89 / $4,365.16 / $4,365.16