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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

Facilitymedian $603 · 10th–90th $186–$7760%20%10th90th$603Professionalmedian $174 · 10th–90th $145–$3020%20%10th90th$174$100.0$200.0$500.0$1.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Small sample — interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$144.54 / $169.82 / $512.86
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$489.78 / $660.69 / $776.25
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$131.83 / $173.78 / $354.81
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 / $229.09
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$151.36 / $186.21 / $416.87
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$141.25 / $177.83 / $275.42