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Montana rates for HCPCS L1200

Thoracic-lumbar-sacral orthosis (TLSO), inclusive of furnishing initial orthosis only

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$927.38 / $6,790.58 / $6,790.58
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,067.17 / $2,067.17 / $2,067.17
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,184.20 / $2,222.62 / $2,222.62
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,184.20 / $2,222.62 / $2,222.62
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$984.12 / $2,116.78 / $2,222.62
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,184.20 / $1,668.18 / $2,240.15
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$795.92 / $880.62 / $1,012.79