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New Jersey 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 $115 · 10th–90th $112–$3390%50%10th90th$115Professionalmedian $166 · 10th–90th $129–$3310%10%10th90th$166$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. Small sample — interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$112.20 / $112.20 / $112.20
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$128.82 / $158.49 / $234.42
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$229.09 / $229.09 / $338.84
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$165.96 / $165.96 / $229.09
Emblem Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$218.78 / $309.03 / $457.09
Horizon BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$331.13 / $331.13 / $331.13
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$114.82 / $169.82 / $354.81
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$151.36 / $177.83 / $323.59