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Montana rates for HCPCS L0641

Lumbar orthosis (LO), sagittal control, with rigid posterior panel(s), posterior extends from L-1 to below L-5 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include padding, stays, shoulder straps, pendulous abdomen design, prefabricated, off-the-shelf

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.89 / $40.74 / $104.71
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.86 / $75.86 / $75.86
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$52.48 / $81.28 / $81.28
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.67 / $81.28 / $81.28
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$37.15 / $43.65 / $109.65
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$37.15 / $43.65 / $109.65
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21.88 / $56.23 / $89.13
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.65 / $79.43 / $81.28
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$41.69 / $44.67 / $52.48
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.81 / $41.69 / $46.77