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Nevada 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 $112 · 10th–90th $112–$3390%50%90th$112Professionalmedian $166 · 10th–90th $132–$2880%10%10th90th$166$5.0$20.0$100.0$500.0

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
$131.83 / $162.18 / $251.19
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$338.84 / $338.84 / $354.81
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$186.21 / $186.21 / $239.88
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$162.18 / $229.09 / $263.03
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$151.36 / $165.96 / $229.09
Hometown Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$194.98 / $338.84 / $588.84
Select Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$331.13 / $338.84 / $354.81
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$114.82 / $151.36 / $177.83
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$141.25 / $218.78 / $389.05