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Texas rates for HCPCS L0643

Lumbar-sacral orthosis (LSO), sagittal control, with rigid posterior panel(s), posterior extends from sacrococcygeal junction to T-9 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include padding, stays, shoulder straps, pendulous abdomen design, prefabricated, off-the-shelf

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64.57 / $67.61 / $67.61
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.66 / $75.86 / $112.20
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,162.28 / $3,548.13 / $4,265.80
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.86 / $75.86 / $75.86
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$79.43 / $117.49 / $117.49
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$128.82 / $128.82 / $128.82
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$93.33 / $93.33 / $128.82
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$537.03 / $537.03 / $537.03
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$812.83 / $812.83 / $812.83
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$38.90 / $93.33 / $245.47
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.23 / $72.44 / $112.20
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$114.82 / $114.82 / $114.82
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$436.52 / $436.52 / $436.52
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$45.71 / $117.49 / $245.47
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$93.33 / $93.33 / $128.82
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$61.66 / $87.10 / $165.96
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.44 / $109.65 / $138.04
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$117.49 / $117.49 / $117.49