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Montana rates for HCPCS L0643

Lumbar-Sacral Orthosis Sagittal Control With Rigid Posterior Panel(S) Posterior Extends From Sacrococcygeal Junction To T-9 Vertebra Produces Intracavitary Pressure To Reduce Load On The Intervertebral Discs Includes Straps Closures May Include Padding Stays Shoulder Straps Pendulousabdomen Design Prefabricated Off-The-Shelf

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.44 / $549.51 / $549.51
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$128.79 / $168.07 / $168.07
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$128.79 / $168.07 / $168.07
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64.33 / $128.79 / $168.07
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.64 / $122.18 / $168.07
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$81.88 / $86.98 / $137.94