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Montana rates for HCPCS L0627

Lumbar orthosis (LO), sagittal control, with rigid anterior and posterior panels, posterior extends from L-1 to below L-5 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include padding, shoulder straps, pendulous abdomen design, 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
$265.79 / $265.79 / $265.79
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$489.93 / $489.93 / $489.93
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$312.81 / $526.77 / $526.77
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$312.81 / $526.77 / $526.77
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$246.72 / $501.69 / $526.77
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$312.81 / $395.36 / $527.15
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$199.54 / $220.78 / $337.85