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Montana rates for HCPCS L0976

Lumbar-sacral orthosis (LSO), full corset

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.44 / $125.89 / $213.80
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$223.87 / $223.87 / $223.87
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$117.49 / $239.88 / $239.88
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.11 / $194.98 / $239.88
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$173.78 / $223.87 / $436.52
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$173.78 / $223.87 / $436.52
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$109.65 / $186.21 / $275.42
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $181.97 / $239.88
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$89.13 / $102.33 / $112.20
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$81.28 / $89.13 / $120.23