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Montana rates for HCPCS L1220

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.13 / $960.18 / $960.18
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$254.13 / $254.13 / $254.13
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$185.61 / $273.24 / $273.24
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$185.61 / $222.21 / $273.24
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$139.15 / $260.23 / $273.24
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$185.61 / $205.08 / $290.62
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$112.54 / $124.52 / $190.54