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Montana rates for HCPCS L0642

Lumbar orthosis (LO), sagittal control, with rigid anterior and posterior panels, 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, shoulder straps, pendulous abdomen design, prefabricated, off-the-shelf

Facilitymedian $240 · 10th–90th $200–$5750%20%10th90th$240Professionalmedian $219 · 10th–90th $115–$4170%10%10th90th$219$100.0$200.0$500.0

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
$91.20 / $190.55 / $371.54
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$398.11 / $398.11 / $398.11
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$302.00 / $426.58 / $426.58
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$302.00 / $426.58 / $426.58
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$199.53 / $229.09 / $575.44
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$199.53 / $229.09 / $575.44
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$138.04 / $309.03 / $467.74
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$79.43 / $257.04 / $426.58
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$218.78 / $234.42 / $275.42
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$208.93 / $218.78 / $346.74