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Montana rates for HCPCS L0636

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

Facilitymedian $1,820 · 10th–90th $1,148–$2,2910%20%40%10th90th$1,820Professionalmedian $1,047 · 10th–90th $724–$2,2910%10%10th90th$1,047$100.0$200.0$500.0$1.0K$2.0K$5.0K$10.0K

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
$724.44 / $977.24 / $1,412.54
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,023.29 / $1,949.84 / $1,949.84
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,023.29 / $1,949.84 / $1,949.84
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,445.44 / $1,819.70 / $3,548.13
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,445.44 / $1,819.70 / $3,548.13
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$870.96 / $1,513.56 / $2,238.72
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$79.43 / $1,479.11 / $1,949.84
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$794.33 / $1,000.00 / $1,047.13
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$724.44 / $794.33 / $1,230.27