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Ohio 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 $355 · 10th–90th $182–$6030%20%40%10th90th$355Professionalmedian $182 · 10th–90th $145–$3090%50%10th90th$182$0.2$1.0$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. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$181.97 / $263.03 / $323.59
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$134.90 / $169.82 / $234.42
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$346.74 / $363.08 / $741.31
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$165.96 / $204.17 / $446.68
CareSource
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$169.82 / $288.40 / $407.38
CareSource
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$223.87 / $309.03 / $467.74
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$229.09 / $229.09 / $239.88
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$165.96 / $165.96 / $229.09
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$229.09 / $229.09 / $229.09
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$165.96 / $165.96 / $229.09
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$186.21 / $295.12 / $426.58
SummaCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$416.87 / $416.87 / $416.87
SummaCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$331.13 / $389.05 / $724.44
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$117.49 / $275.42 / $416.87
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$112.20 / $162.18 / $234.42