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Oregon 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 $324 · 10th–90th $251–$3470%50%10th90th$324Professionalmedian $200 · 10th–90th $145–$3720%10%10th90th$200$100.0$500.0$2.0K$10.0K

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
$199.53 / $199.53 / $199.53
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$134.90 / $181.97 / $251.19
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 / $165.96
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$257.04 / $676.08 / $812.83
Moda Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$199.53 / $251.19 / $338.84
Moda Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$245.47 / $263.03 / $363.08
Pacific Source
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$263.03 / $323.59 / $338.84
Pacific Source
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$331.13 / $331.13 / $346.74
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$194.98 / $275.42 / $398.11
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$79.43 / $288.40 / $354.81
Regence BlueShield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$275.42 / $524.81 / $1,318.26
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$338.84 / $371.54 / $371.54
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$117.49 / $169.82 / $501.19
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$134.90 / $151.36 / $288.40