go back

Oklahoma 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 $170 · 10th–90th $155–$5620%20%10th90th$170Professionalmedian $162 · 10th–90th $132–$2190%20%10th90th$162$100.0$200.0$500.0$1.0K$2.0K

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
$162.18 / $162.18 / $162.18
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$151.36 / $169.82 / $204.17
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 / $371.54
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$154.88 / $218.78 / $1,584.89
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$102.33 / $162.18 / $416.87
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$147.91 / $218.78 / $354.81
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$102.33 / $151.36 / $218.78