Thoracolumbosacral orthosis, rigid plastic back brace

Hospitals report these codes with terse, inconsistent chargemaster text. This plain-English title was written by an AI model from that text and has not been reviewed by a person, so it can be wrong. The prices on this page come straight from hospital filings and do not depend on it.

Model: claude-haiku-5-5
Provider: anthropic
API: message_batches
Reasoning effort: low
Max output tokens: 4096
Prompt version (hash): 444523875572
Generated: October 20, 2026

Original text from hospital filings

TLSO rigid plastic pre one

Payers reporting HCPCS L0490

Payer pricing summary

Low

$88

Average

$483

Median

$370

High

$1.7k

Payer rate distribution

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Filter by billing class

#
1	UnitedHealthcare fee schedule · outpatient · +13 other terms	368	$351	$374	$220	59%	—	$152 – $2.7k
2	Aetna fee schedule · outpatient · +12 other terms	359	$351	$402	$186	46%	—	$174 – $2.3k
3	Humana fee schedule · outpatient · +9 other terms	317	$348	$522	$560	107%	—	$178 – $2.7k
4	Blue Cross Blue Shield fee schedule · outpatient · +10 other terms	218	$357	$458	$241	53%	—	$0 – $1.7k
5	WellCare fee schedule · outpatient · +6 other terms	208	$360	$369	$55	15%	—	$333 – $662
6	Devoted fee schedule · outpatient · +3 other terms	165	$350	$351	$8	2%	—	$338 – $422
7	Molina fee schedule · outpatient · +4 other terms	138	$498	$484	$181	37%	—	$261 – $916
8	Cigna Healthspring fee schedule · outpatient · +1 other terms	116	$356	$356	$12	3%	—	$349 – $426
9	Cigna fee schedule · outpatient · +11 other terms	103	$360	$417	$235	56%	—	$338 – $2.7k
10	Anthem fee schedule · outpatient · +6 other terms	81	$345	$482	$458	95%	—	$333 – $2.6k
11	Kaiser fee schedule · outpatient · +5 other terms	64	$358	$558	$391	70%	—	$338 – $2.5k
12	Caresource fee schedule · outpatient · +5 other terms	41	$350	$399	$143	36%	—	$191 – $869
13	Superior Healthplan fee schedule · outpatient	40	$367	$367	$2	0%	—	$343 – $367
14	Clover fee schedule · outpatient · +3 other terms	37	$350	$352	$19	5%	—	$333 – $414
15	Oscar fee schedule · outpatient · +4 other terms	36	$367	$403	$86	21%	—	$342 – $588
16	Ambetter facility · fee schedule · outpatient · +6 other terms	35	$626	$646	$167	26%	—	$252 – $874
17	Optum fee schedule · outpatient · +3 other terms	33	$350	$457	$185	41%	—	$335 – $874
18	Medica facility · fee schedule · outpatient · +5 other terms	22	$355	$326	$85	26%	—	$116 – $576
19	Regence facility · fee schedule · outpatient · +3 other terms	19	$365	$351	$28	8%	—	$283 – $373
20	Amerihealth Caritas fee schedule · outpatient · +1 other terms	18	$419	$408	$23	6%	—	$346 – $419
21	Bcbs Tx fee schedule · outpatient	18	$343	$343	—	—	—	$343 – $343
22	Medicare fee schedule · outpatient · +1 other terms	18	$338	$339	$3	1%	—	$338 – $345
23	Medical Mutual facility · fee schedule · outpatient · +1 other terms	15	$348	$401	$99	25%	—	$189 – $549
24	Bcbs Mn fee schedule · outpatient · +6 other terms	13	$316	$316	$74	23%	—	$154 – $370
25	Wellmark fee schedule · both · +1 other terms	13	$332	$330	$13	4%	—	$253 – $332

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