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Montana rates for HCPCS L0626

Lumbar Orthosis Sagittal Control With Rigid Posterior Panel(S) Posterior Extends From L-1 To L-5 Vertebra Produces Intracavitary Pressure To Reduce Load On The Intervertebral Discs Includes Straps Closures May Include Padding Stays Shoulder Straps Pendulous Abdomen Design Pre- Fabricated Item That Has Been Trimmed Bent Molded Assembled Or Otherwise Customized To Fit A Specific Patient By An Individual With Expertise(Revised 01/01/14)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.39 / $50.39 / $55.44
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$92.89 / $92.89 / $92.89
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$58.60 / $99.88 / $99.88
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$58.60 / $99.88 / $99.88
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$46.78 / $95.12 / $99.88
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$58.60 / $74.95 / $99.95
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$37.84 / $41.86 / $64.06