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Montana rates for HCPCS L1120

Addition to cervical-thoracic-lumbar-sacral orthosis (CTLSO), scoliosis orthosis, cover for upright, each

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.91 / $30.90 / $47.86
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$29.51 / $51.29 / $51.29
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.88 / $41.69 / $51.29
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$37.15 / $46.77 / $91.20
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$37.15 / $46.77 / $91.20
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$26.92 / $44.67 / $61.66
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.31 / $51.29 / $79.43
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21.88 / $25.12 / $28.18
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.95 / $22.39 / $26.30