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Montana rates for HCPCS L0648

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$231.00 / $761.22 / $3,483.15
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$988.74 / $988.74 / $988.74
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$758.68 / $1,065.47 / $1,065.47
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$758.68 / $1,065.47 / $1,065.47
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$407.79 / $758.68 / $1,065.47
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$580.91 / $758.68 / $1,065.47
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$519.01 / $551.38 / $620.37