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Montana rates for HCPCS L0650

Lumbar-sacral orthosis (LSO), sagittal-coronal control, with rigid anterior and posterior frame/panel(s), posterior extends from sacrococcygeal junction to T-9 vertebra, lateral strength provided by rigid lateral frame/panel(s), produces intracavitary pressure to reduce load on 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
$456.42 / $791.01 / $1,578.80
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47,000.00 / $81,499.99 / $94,999.99
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,053.02 / $1,053.02 / $1,053.02
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$812.83 / $1,134.96 / $1,134.96
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$812.83 / $1,134.96 / $1,134.96
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$471.84 / $812.83 / $1,134.96
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$635.41 / $812.83 / $1,134.96
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$361.61 / $630.26 / $999.59