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Montana rates for HCPCS L0628

Lumbar-sacral orthosis (LSO), flexible, provides lumbo-sacral support, posterior extends from sacrococcygeal junction to T-9 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include stays, shoulder straps, pendulous abdomen design, prefabricated, off-the-shelf

Facilitymedian $56 · 10th–90th $41–$1230%20%10th90th$56Professionalmedian $41 · 10th–90th $23–$850%10%20%10th90th$41$10.0$50.0$200.0$1.0K$5.0K$20.0K$100.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$18.20 / $33.88 / $74.13
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$112.20 / $69,183.10 / $95,499.26
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$81.28 / $81.28 / $81.28
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$57.54 / $87.10 / $87.10
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$57.54 / $87.10 / $87.10
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$40.74 / $48.98 / $85.11
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$40.74 / $48.98 / $85.11
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$28.84 / $64.57 / $112.20
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$47.86 / $79.43 / $87.10
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$44.67 / $47.86 / $56.23
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$40.74 / $44.67 / $69.18