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Montana rates for HCPCS L0635

Lumbar-sacral orthosis (LSO), sagittal-coronal control, lumbar flexion, rigid posterior frame/panel(s), lateral articulating design to flex the lumbar spine, posterior extends from sacrococcygeal junction to T-9 vertebra, lateral strength provided by rigid lateral frame/panel(s), produces intracavitary pressure to reduce load on intervertebral discs, includes straps, closures, may include padding, anterior panel, pendulous abdomen design, prefabricated, includes fitting and adjustment

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$566.54 / $4,148.45 / $4,148.45
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$711.81 / $1,132.29 / $1,132.29
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$711.81 / $1,132.29 / $1,132.29
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$601.22 / $1,078.36 / $1,132.29
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$711.81 / $849.83 / $1,182.78
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$486.24 / $537.98 / $823.26