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Minnesota rates for HCPCS L1290

Addition to thoracic-lumbar-sacral orthosis (TLSO), (low profile), lateral trochanteric pad

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64.57 / $64.57 / $64.57
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.90 / $52.48 / $72.44
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$91.20 / $93.33 / $138.04
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$74.13 / $93.33 / $93.33
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$199.53 / $346.74 / $831.76
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$107.15 / $123.03 / $138.04
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$269.15 / $346.74 / $660.69
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$107.15 / $107.15 / $147.91
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$38.90 / $93.33 / $295.12
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.51 / $44.67 / $102.33
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.71 / $43.65 / $131.83
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.90 / $45.71 / $114.82