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Texas rates for HCPCS L0628

Lumbar-Sacral Orthosis Flexible Provides Lumbo-Sacral Support Posterior Extends From Sacro- Coccygeal Juntion To T-9 Vertebra Produces Intra-Cavitary Pressure To Reduce Load On The Inter- Vertebral Discs Includes Straps Closures May Include Stays Shoulder Straps Pendulous Abdomen Design Prefabricated Off-The-Shelf (Revised 01/01/14)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$33.56 / $34.88 / $35.63
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.90 / $34.88 / $56.60
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
$39.58 / $39.58 / $51.19
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$59.83 / $59.83 / $59.83
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$57.67 / $57.67 / $57.67
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.10 / $42.10 / $57.67
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$109.34 / $275.93 / $275.93
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$420.15 / $421.74 / $421.74
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$29.09 / $59.83 / $78.11
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.95 / $50.86 / $79.52
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.00 / $63.91 / $229.15
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$29.09 / $57.67 / $76.36
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.10 / $42.10 / $63.68
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$37.54 / $54.29 / $64.64
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.13 / $54.36 / $59.83