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Texas rates for HCPCS L1240

Addition to thoracic-lumbar-sacral orthosis (TLSO), (low profile), lumbar derotation pad

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$42.18 / $43.84 / $100.75
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.15 / $43.84 / $71.13
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.06 / $67.06 / $67.06
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.96 / $44.96 / $56.24
Baylor Scott & White
Facility/Professional
Facility
Modifier
Low / Median / High Price
$70.84 / $70.84 / $94.46
Baylor Scott & White
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.12 / $70.84 / $94.46
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$94.46 / $94.46 / $94.46
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$62.81 / $62.81 / $62.81
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.85 / $45.85 / $62.81
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$222.45 / $468.00 / $553.99
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$596.48 / $610.79 / $662.10
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$28.17 / $65.36 / $94.46
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.17 / $86.90 / $96.90
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.60 / $54.60 / $54.60
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$28.17 / $63.12 / $94.46
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.85 / $45.85 / $66.95
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.36 / $52.59 / $62.61
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.40 / $52.62 / $94.46