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Minnesota rates for HCPCS L0490

Tlso Sagittal-Coronal Control One Piece Rigid Plastic Shell With Overlapping Reinforced Anterior With Multiple Straps And Closures Posterior Extends From Scarococcygeal Junction And Terminates At Or Before The T-9 Vertebra Anterior Extends Fromsymphysis Pubis To Xiphoid Anterior Opening Restricts Gross Trunk Motion In Sagittal And Coronal Planes Prefabricated Includes Fitting And Adjustment

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$236.81 / $236.81 / $236.81
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$157.34 / $236.81 / $250.66
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$293.74 / $363.78 / $479.19
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$272.66 / $323.77 / $340.82
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$227.96 / $1,051.09 / $2,919.35
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$395.25 / $418.97 / $501.97
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$624.03 / $1,008.48 / $2,298.69
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$395.25 / $395.25 / $406.40
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$101.00 / $340.82 / $1,593.03
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$101.26 / $168.64 / $373.07
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$101.26 / $154.34 / $342.25