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Montana rates for HCPCS L1210

Addition to thoracic-lumbar-sacral orthosis (TLSO), (low profile), lateral thoracic extension

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$154.87 / $1,134.03 / $1,134.03
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$383.83 / $383.83 / $383.83
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$190.69 / $412.69 / $412.69
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$190.69 / $335.61 / $412.69
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$164.35 / $393.04 / $412.69
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$190.69 / $309.74 / $412.99
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$132.91 / $147.07 / $168.35