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Virginia 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 $339 · 10th–90th $162–$4370%20%40%10th90th$339Professionalmedian $182 · 10th–90th $135–$3090%50%10th90th$182$0.2$2.0$20.0$200.0$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
$134.90 / $162.18 / $426.58
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$134.90 / $162.18 / $302.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$338.84 / $338.84 / $363.08
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$186.21 / $186.21 / $389.05
CareFirst
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$288.40 / $288.40 / $288.40
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$144.54 / $229.09 / $229.09
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$165.96 / $165.96 / $223.87
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$257.04 / $338.84 / $478.63
Medcost
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$169.82 / $223.87 / $331.13
Medcost
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$134.90 / $218.78 / $389.05
Medcost
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$181.97 / $204.17 / $426.58
Sentara
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$190.55 / $288.40 / $1,071.52
Sentara
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$190.55 / $288.40 / $1,071.52
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$102.33 / $151.36 / $416.87
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$151.36 / $165.96 / $269.15