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North Dakota 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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$250.66 / $250.66 / $250.66
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$236.81 / $236.81 / $250.66
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$322.14 / $380.88 / $390.36
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$395.25 / $399.20 / $501.97
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$159.01 / $250.66 / $1,593.03
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$137.26 / $168.64 / $274.51
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$101.26 / $168.64 / $274.51