go back

Arkansas rates for HCPCS L1200

Thoracic-lumbar-sacral orthosis (TLSO), inclusive of furnishing initial orthosis only

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,128.36 / $1,128.36 / $1,128.36
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$768.16 / $1,128.36 / $1,128.36
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,624.08 / $1,624.08 / $1,624.08
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
$1,752.55 / $2,319.55 / $2,577.28
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,765.16 / $1,765.16 / $1,957.87
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,765.16 / $1,765.16 / $1,765.16
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,184.20 / $1,184.20 / $1,624.08
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$864.47 / $1,184.20 / $1,586.02
Qualchoice
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,867.69 / $1,867.69 / $1,867.69
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$587.08 / $914.47 / $1,220.51