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Texas 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 $263 · 10th–90th $151–$9550%10%20%10th90th$263Professionalmedian $166 · 10th–90th $145–$2450%50%10th90th$166$0.2$1.0$5.0$20.0$100.0$500.0$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
$151.36 / $151.36 / $158.49
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$144.54 / $162.18 / $223.87
Christus
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$79.43 / $346.74 / $346.74
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
Lucent Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,621.81 / $1,621.81 / $1,621.81
Lucent Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,511.89 / $2,511.89 / $4,365.16
Moda Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$147.91 / $269.15 / $457.09
Moda Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$151.36 / $165.96 / $338.84
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$257.04 / $257.04 / $263.03
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$147.91 / $257.04 / $457.09
Providence
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
$117.49 / $218.78 / $354.81
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $181.97 / $218.78
Wellpoint
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$181.97 / $346.74 / $346.74