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Arkansas rates for HCPCS L0638

Lumbar-sacral orthosis (LSO), sagittal-coronal control, with rigid anterior and posterior frame/panels, 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, shoulder straps, pendulous abdomen design, custom fabricated

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$887.95 / $887.95 / $887.95
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$661.97 / $887.95 / $887.95
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
$1,379.15 / $1,825.34 / $2,028.16
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,551.00 / $1,551.00 / $1,597.72
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,551.00 / $1,551.00 / $1,551.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,115.23 / $1,115.23 / $1,278.05
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$814.12 / $1,115.23 / $1,248.09
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$472.15 / $719.62 / $962.62