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Texas rates for HCPCS L1110

Addition to cervical-thoracic-lumbar-sacral orthosis (CTLSO) or scoliosis orthosis, ring flange, plastic or leather, molded to patient model

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$129.63 / $132.16 / $134.72
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.21 / $134.72 / $227.25
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$290.27 / $290.27 / $290.27
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$225.30 / $225.30 / $225.30
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$164.47 / $164.47 / $225.30
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$778.79 / $1,533.12 / $1,822.29
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,110.67 / $2,161.35 / $2,161.35
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$92.67 / $202.30 / $290.27
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$92.67 / $262.27 / $336.73
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$92.67 / $202.30 / $290.27
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$164.47 / $164.47 / $232.06
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$326.08 / $326.08 / $383.64
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$118.81 / $168.59 / $205.93
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$172.38 / $175.24 / $290.27