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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
$616.60 / $977.24 / $1,445.44
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,584.89 / $1,584.89 / $1,584.89
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,122.02 / $1,698.24 / $1,698.24
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$812.83 / $1,380.38 / $1,698.24
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,230.27 / $1,584.89 / $3,090.30
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,230.27 / $1,584.89 / $3,090.30
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$831.76 / $1,348.96 / $1,949.84
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $1,258.93 / $1,698.24
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$707.95 / $891.25 / $933.25
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$645.65 / $707.95 / $812.83