go back

Utah rates for HCPCS L0490

Tlso Sagittal-Coronal Control One Piece Rigid Plastic Shell With Overlapping Reinforced Anterior With Multiple Straps And Closures Posterior Extends From Scarococcygeal Junction And Terminates At Or Before The T-9 Vertebra Anterior Extends Fromsymphysis 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
$98.06 / $98.06 / $98.06
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$98.06 / $113.61 / $959.87
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 / $234.80
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$155.94 / $251.52 / $326.97
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$301.68 / $336.46 / $336.46
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$191.58 / $241.18 / $361.77
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$116.70 / $150.54 / $178.40