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Montana rates for HCPCS L0456

Thoracic-lumbar-sacral orthosis (TLSO), flexible, provides trunk support, thoracic region, rigid posterior panel and soft anterior apron, extends from the sacrococcygeal junction and terminates just inferior to the scapular spine, restricts gross trunk motion in the sagittal plane, produces intracavitary pressure to reduce load on the intervertebral disks, includes straps and closures, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$460.87 / $642.95 / $3,374.57
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,183.08 / $1,183.08 / $1,183.08
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$736.69 / $1,272.05 / $1,272.05
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$736.69 / $1,272.05 / $1,272.05
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$596.83 / $1,211.48 / $1,272.05
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$942.16 / $975.89 / $1,272.98
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$482.69 / $534.05 / $611.35