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Arkansas rates for HCPCS L0490

Thoracic-lumbar-sacral orthosis (TLSO), sagittal-coronal control, one-piece rigid plastic shell, with overlapping reinforced anterior, with multiple straps and closures, posterior extends from sacrococcygeal junction and terminates at or before the T-9 vertebra, anterior extends from symphysis pubis to xiphoid, anterior opening, restricts gross trunk motion in sagittal and coronal planes, prefabricated, includes fitting and adjustment

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$190.44 / $190.44 / $190.44
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$141.97 / $190.44 / $190.44
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
$295.79 / $391.48 / $434.98
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$332.68 / $332.68 / $342.66
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$332.68 / $332.68 / $332.68
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$227.96 / $227.96 / $274.10
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$166.41 / $227.96 / $267.68
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$101.26 / $154.34 / $206.46