go back

Virginia 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
$136.16 / $164.49 / $164.49
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$136.16 / $164.49 / $183.06
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$332.68 / $332.68 / $353.31
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$185.44 / $185.44 / $236.89
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$291.31 / $291.31 / $291.31
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 / $166.41 / $227.96
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$232.88 / $299.41 / $399.22
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$98.06 / $204.60 / $378.70
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$192.00 / $415.85 / $554.14
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$182.27 / $260.38 / $575.29
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$182.27 / $260.38 / $575.29
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$137.91 / $165.97 / $255.62