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Montana rates for HCPCS L0466

Thoracic-lumbar-sacral orthosis (TLSO), sagittal control, rigid posterior frame and flexible soft anterior apron with straps, closures and padding, restricts gross trunk motion in sagittal plane, produces intracavitary pressure to reduce load on intervertebral disks, 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
$221.14 / $1,619.24 / $1,619.24
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$295.70 / $461.77 / $461.77
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$295.70 / $375.52 / $461.77
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$234.66 / $439.78 / $461.77
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$295.70 / $346.58 / $505.75
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$238.12 / $238.12 / $262.49
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$189.79 / $209.99 / $240.61