go back

New Mexico 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 $234 · 10th–90th $98–$3550%10%10th90th$234Professionalmedian $170 · 10th–90th $141–$3090%20%10th90th$170$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
Facility
Modifier
Typical Low / Median / Typical High
$169.82 / $169.82 / $169.82
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$151.36 / $169.82 / $257.04
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$229.09 / $229.09 / $229.09
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$165.96 / $165.96 / $416.87
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$275.42 / $338.84 / $512.86
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$97.72 / $245.47 / $346.74
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$165.96 / $165.96 / $346.74
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$138.04 / $162.18 / $416.87
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$138.04 / $151.36 / $229.09