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Arkansas rates for HCPCS L0643

Lumbar-Sacral Orthosis Sagittal Control With Rigid Posterior Panel(S) Posterior Extends From Sacrococcygeal Junction To T-9 Vertebra Produces Intracavitary Pressure To Reduce Load On The Intervertebral Discs Includes Straps Closures May Include Padding Stays Shoulder Straps Pendulousabdomen Design Prefabricated Off-The-Shelf

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$109.03 / $109.03 / $109.03
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.05 / $109.03 / $109.03
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
$105.13 / $139.15 / $154.61
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$122.50 / $122.50 / $122.50
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$122.50 / $122.50 / $122.50
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$98.00 / $128.79 / $128.79
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$94.02 / $95.14 / $128.79
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.99 / $92.11 / $127.46