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Texas rates for HCPCS L0625

Lumbar orthosis (LO), flexible, provides lumbar support, posterior extends from L-1 to below L-5 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include pendulous abdomen design, shoulder straps, stays, prefabricated, off-the-shelf

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.40 / $17.85 / $5,075.81
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.61 / $22.91 / $37.18
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.65 / $40.65 / $40.65
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,456.92 / $5,821.21 / $8,577.84
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.00 / $26.00 / $33.63
Baylor Scott & White
Facility/Professional
Facility
Modifier
Low / Median / High Price
$29.48 / $29.48 / $39.29
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$39.29 / $43.23 / $43.23
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$38.15 / $38.15 / $42.22
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.43 / $32.43 / $41.92
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$80.00 / $181.21 / $181.21
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$275.95 / $276.89 / $276.89
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19.10 / $39.29 / $51.31
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.84 / $36.15 / $45.20
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.60 / $41.27 / $88.42
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19.10 / $38.15 / $50.16
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.43 / $32.43 / $42.22
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.06 / $55.06 / $64.78
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.66 / $35.65 / $42.45
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.53 / $36.19 / $39.29