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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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$113.61 / $113.61 / $131.09
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$113.61 / $131.09 / $141.97
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$332.68 / $332.68 / $332.68
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$185.44 / $185.44 / $405.96
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$227.96 / $227.96 / $244.91
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$166.41 / $215.74 / $234.80
Hometown Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$185.00 / $266.14 / $479.06
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$118.93 / $151.90 / $253.16