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Montana rates for HCPCS L1250

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.45 / $266.95 / $266.95
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.48 / $79.48 / $79.48
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$61.62 / $85.46 / $85.46
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.62 / $69.50 / $85.46
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$45.38 / $81.39 / $85.46
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.62 / $64.14 / $88.06
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.70 / $40.61 / $67.68