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Montana rates for HCPCS L0638

Lumbar-sacral orthosis (LSO), sagittal-coronal control, with rigid anterior and posterior frame/panels, 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, shoulder straps, pendulous abdomen design, custom fabricated

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$611.15 / $4,475.02 / $4,475.02
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,568.91 / $1,568.91 / $1,568.91
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,115.23 / $1,686.89 / $1,686.89
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,115.23 / $1,686.89 / $1,686.89
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$791.46 / $1,606.56 / $1,686.89
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,115.23 / $1,266.08 / $1,688.11
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$640.10 / $708.22 / $1,083.77