go back

Wisconsin 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 $347 · 10th–90th $324–$6310%50%10th90th$347Professionalmedian $224 · 10th–90th $151–$5250%20%10th90th$224$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
$169.82 / $169.82 / $169.82
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$144.54 / $169.82 / $251.19
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$346.74 / $346.74 / $575.44
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$316.23 / $323.59 / $380.19
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$229.09 / $794.33 / $1,698.24
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$165.96 / $489.78 / $660.69
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$173.78 / $281.84 / $426.58
DeanCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$194.98 / $331.13 / $416.87
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$173.78 / $338.84 / $1,584.89
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$151.36 / $177.83 / $380.19
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$54.95 / $70.79 / $1,047.13
Network Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$549.54 / $549.54 / $549.54
Network Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$245.47 / $389.05 / $676.08
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$346.74 / $524.81 / $954.99
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$229.09 / $691.83 / $1,584.89
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$165.96 / $331.13 / $4,365.16
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$102.33 / $177.83 / $346.74
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$120.23 / $169.82 / $288.40