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Texas 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
$153.01 / $156.01 / $159.01
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$144.78 / $159.01 / $258.02
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$342.63 / $342.63 / $342.63
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$227.96 / $227.96 / $227.96
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$166.41 / $166.41 / $227.96
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$572.58 / $1,593.03 / $1,593.03
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,495.10 / $4,160.85 / $4,327.29
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$98.06 / $237.06 / $342.63
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$98.06 / $308.37 / $342.63
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$359.76 / $359.76 / $366.95
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$98.06 / $228.94 / $342.63
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$166.41 / $166.41 / $234.80
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$126.58 / $183.05 / $217.91
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$182.41 / $185.44 / $342.63