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Montana rates for HCPCS L1280

Addition to thoracic-lumbar-sacral orthosis (TLSO), (low profile), rib gusset (elastic), each

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.06 / $373.89 / $373.89
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$73.27 / $102.05 / $102.05
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$73.27 / $82.99 / $102.05
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$54.18 / $97.19 / $102.05
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$73.27 / $76.59 / $102.12
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.82 / $48.49 / $74.19