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Arkansas rates for HCPCS L0455

Thoracic-lumbar-sacral orthosis (TLSO), flexible, provides trunk support, extends from sacrococcygeal junction to above T-9 vertebra, restricts gross trunk motion in the sagittal plane, produces intracavitary pressure to reduce load on the intervertebral disks with rigid stays or panel(s), includes shoulder straps and closures, prefabricated, off-the-shelf

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$233.50 / $233.50 / $233.50
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$160.69 / $233.50 / $233.50
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$219,999.78 / $539,999.46 / $949,999.05
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$225.11 / $297.95 / $331.05
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$262.27 / $262.27 / $262.27
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$262.27 / $262.27 / $262.27
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$209.82 / $278.10 / $278.10
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$203.01 / $203.72 / $278.10
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$124.16 / $197.27 / $272.95