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Texas rates for HCPCS L1250

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.92 / $41.72 / $42.53
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.11 / $42.53 / $69.01
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.61 / $54.56 / $54.56
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$91.64 / $91.64 / $91.64
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$61.62 / $61.62 / $61.62
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.98 / $44.98 / $61.62
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$434.49 / $439.47 / $439.47
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$453.62 / $461.16 / $610.42
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$26.21 / $63.41 / $91.64
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.21 / $82.48 / $91.64
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$26.21 / $61.62 / $91.64
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.98 / $44.98 / $65.68
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.84 / $48.94 / $60.96
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.77 / $49.30 / $91.64