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New York 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 $269 · 10th–90th $145–$6170%20%10th90th$269Professionalmedian $186 · 10th–90th $145–$4900%20%40%10th90th$186$0.2$2.0$20.0$200.0$2.0K$20.0K

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
$112.20 / $269.15 / $380.19
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$128.82 / $165.96 / $234.42
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$338.84 / $338.84 / $676.08
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$186.21 / $186.21 / $549.54
CDPHP
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$257.04 / $275.42 / $275.42
CDPHP
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$275.42 / $275.42 / $275.42
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$229.09 / $229.09 / $53,703.18
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$165.96 / $165.96 / $398.11
Emblem Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$338.84 / $562.34 / $1,288.25
Emblem Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$213.80 / $338.84 / $645.65
Excellus BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$251.19 / $251.19 / $263.03
Excellus BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$199.53 / $213.80 / $251.19
MVP Health Care
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$537.03 / $50,118.72 / $75,857.76
MVP Health Care
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$223.87 / $323.59 / $323.59
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$125.89 / $173.78 / $933.25
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $218.78 / $562.34
Univera
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$199.53 / $223.87 / $263.03
Univera
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$199.53 / $213.80 / $251.19