go back

Washington 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 $224–$8130%20%10th90th$339Professionalmedian $224 · 10th–90th $145–$4900%10%10th90th$224$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
$223.87 / $223.87 / $537.03
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$144.54 / $181.97 / $302.00
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$288.40 / $323.59 / $323.59
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$288.40 / $288.40 / $371.54
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
Kaiser Permanente
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$208.93 / $457.09 / $933.25
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$208.93 / $426.58 / $707.95
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$75.86 / $257.04 / $281.84
Pacific Source
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$263.03 / $323.59 / $338.84
Pacific Source
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$331.13 / $331.13 / $363.08
Premera BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$288.40 / $489.78 / $660.69
Premera BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$275.42 / $275.42 / $323.59
Regence BlueShield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$323.59 / $323.59 / $323.59
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$288.40 / $288.40 / $371.54
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$151.36 / $501.19 / $501.19
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$141.25 / $162.18 / $288.40
Wellpoint
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$239.88 / $288.40 / $794.33