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Arkansas rates for HCPCS L0628

Lumbar-sacral orthosis (LSO), flexible, provides lumbo-sacral support, posterior extends from sacrococcygeal junction to T-9 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include stays, shoulder straps, pendulous abdomen design, prefabricated, off-the-shelf

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56.47 / $56.47 / $56.47
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$37.04 / $56.47 / $56.47
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
$54.45 / $72.06 / $80.08
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$63.45 / $63.45 / $63.45
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.45 / $63.45 / $63.45
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$50.76 / $57.67 / $57.67
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.10 / $42.10 / $76.36
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.04 / $45.05 / $61.09