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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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.88 / $54.24 / $284.68
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47,000.00 / $81,499.99 / $94,999.99
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$80.79 / $80.79 / $80.79
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$57.67 / $87.06 / $87.06
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.67 / $87.06 / $87.06
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$41.65 / $58.15 / $87.06
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.47 / $57.67 / $87.06
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.72 / $45.05 / $50.68