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Arkansas rates for HCPCS L0636

Lumbar-sacral orthosis (LSO), sagittal-coronal control, lumbar flexion, rigid posterior frame/panels, lateral articulating design to flex the lumbar spine, posterior extends from sacrococcygeal junction to T-9 vertebra, lateral strength provided by rigid lateral frame/panels, produces intracavitary pressure to reduce load on intervertebral discs, includes straps, closures, may include padding, anterior panel, pendulous abdomen design, custom fabricated

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$903.04 / $903.04 / $903.04
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$739.88 / $903.04 / $903.04
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
$1,402.57 / $1,856.35 / $2,062.61
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,596.38 / $1,596.38 / $1,900.75
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,596.38 / $1,596.38 / $1,596.38
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,030.36 / $1,030.36 / $1,299.76
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$752.17 / $752.17 / $1,220.98
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$530.94 / $789.31 / $1,073.64