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Rhode Island 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
Professional
Modifier
Low / Median / High Price
$145.36 / $182.86 / $197.31
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$470.37 / $635.28 / $752.10
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$174.83 / $174.83 / $292.39
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$227.96 / $227.96 / $227.96
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$166.41 / $227.96 / $227.96
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$129.94 / $177.82 / $276.62