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Tennessee 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
Facility
Modifier
Low / Median / High Price
$154.16 / $154.16 / $168.44
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$144.78 / $159.01 / $288.55
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$204.17 / $308.39 / $308.39
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$177.82 / $227.96 / $227.96
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$166.41 / $166.41 / $227.96
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$535.41 / $1,593.03 / $1,593.03
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,495.10 / $4,160.85 / $4,327.29
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$113.97 / $163.82 / $228.81