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Arkansas rates for HCPCS L0649

Lumbar-sacral orthosis (LSO), sagittal-coronal control, with rigid posterior frame/panel(s), 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, stays, shoulder straps, pendulous abdomen design, prefabricated, off-the-shelf

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$193.06 / $193.06 / $193.06
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$132.90 / $193.06 / $193.06
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
$186.16 / $246.39 / $273.77
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$216.91 / $216.91 / $216.91
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$216.91 / $216.91 / $216.91
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$173.53 / $211.82 / $211.82
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$154.63 / $168.47 / $211.82
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.68 / $163.12 / $233.21