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Texas rates for HCPCS L1290

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$39.54 / $41.10 / $94.90
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$37.99 / $41.10 / $66.68
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$62.87 / $62.87 / $62.87
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.14 / $42.14 / $52.73
Baylor Scott & White
Facility/Professional
Facility
Modifier
Low / Median / High Price
$66.41 / $66.41 / $88.55
Baylor Scott & White
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.99 / $66.41 / $88.55
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$88.55 / $88.55 / $88.55
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$60.55 / $60.55 / $60.55
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.20 / $44.20 / $60.55
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$298.27 / $470.06 / $560.79
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$942.93 / $965.57 / $965.57
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$28.52 / $61.71 / $88.55
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.52 / $81.47 / $90.45
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.70 / $54.70 / $54.70
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$28.52 / $60.55 / $88.55
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.20 / $44.20 / $64.55
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.35 / $100.35 / $118.06
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.82 / $54.46 / $63.37
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$53.05 / $53.11 / $88.55