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Arkansas rates for HCPCS L1290

Addition to thoracic-lumbar-sacral orthosis (TLSO), (low profile), lateral trochanteric pad

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$49.22 / $49.22 / $49.22
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.53 / $49.22 / $51.58
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.84 / $70.84 / $70.84
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
$76.44 / $101.17 / $112.41
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$92.16 / $92.16 / $112.58
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$92.16 / $92.16 / $92.16
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$60.55 / $60.55 / $70.84
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.20 / $60.55 / $69.18
Qualchoice
Facility/Professional
Professional
Modifier
Low / Median / High Price
$81.47 / $81.47 / $81.47
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.35 / $100.35 / $118.06
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.45 / $42.20 / $59.17