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Montana rates for HCPCS L1290

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46.52 / $340.65 / $340.65
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$86.47 / $86.47 / $86.47
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$60.55 / $92.98 / $92.98
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.55 / $75.61 / $92.98
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$49.37 / $88.55 / $92.98
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.55 / $69.79 / $93.05
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.92 / $44.18 / $70.06