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Nebraska 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 $347 · 10th–90th $151–$1,5850%20%10th90th$347Professionalmedian $214 · 10th–90th $112–$9120%10%10th90th$214$100.0$200.0$500.0$1.0K$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
$213.80 / $213.80 / $213.80
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$97.72 / $213.80 / $1,445.44
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$295.12 / $331.13 / $331.13
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$229.09 / $229.09 / $380.19
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$229.09 / $398.11 / $588.84
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$218.78 / $371.54 / $1,584.89
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$112.20 / $169.82 / $338.84
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$371.54 / $371.54 / $912.01
Midlands
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$380.19 / $380.19 / $380.19
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$467.74 / $851.14 / $912.01
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$117.49 / $181.97 / $354.81
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$123.03 / $169.82 / $263.03