go back

Minnesota 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 $398 · 10th–90th $295–$2,5120%20%10th90th$398Professionalmedian $339 · 10th–90th $170–$3980%20%40%10th90th$339$0.5$2.0$10.0$50.0$200.0$1.0K$5.0K

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
$234.42 / $234.42 / $234.42
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$144.54 / $194.98 / $234.42
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$331.13 / $338.84 / $446.68
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$275.42 / $338.84 / $338.84
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$794.33 / $1,288.25 / $3,019.95
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$398.11 / $446.68 / $501.19
Health Partners
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,023.29 / $1,258.93 / $2,511.89
Health Partners
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$398.11 / $398.11 / $537.03
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$147.91 / $338.84 / $1,584.89
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$102.33 / $151.36 / $407.38
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2.45 / $151.36 / $501.19
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$114.82 / $177.83 / $478.63