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Montana rates for HCPCS L4000

Replace girdle for spinal orthosis (cervical-thoracic-lumbar-sacral orthosis (CTLSO) or spinal orthosis SO)

Facilitymedian $1,585 · 10th–90th $1,000–$1,9950%20%40%10th90th$1,585Professionalmedian $977 · 10th–90th $661–$1,9950%10%20%10th90th$977$100.0$200.0$500.0$1.0K$2.0K$5.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$660.69 / $912.01 / $1,412.54
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$891.25 / $1,698.24 / $1,698.24
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$891.25 / $1,698.24 / $1,698.24
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,258.93 / $1,584.89 / $3,090.30
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,258.93 / $1,584.89 / $3,090.30
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$794.33 / $1,513.56 / $1,949.84
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$79.43 / $1,288.25 / $1,698.24
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$707.95 / $812.83 / $891.25
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$645.65 / $724.44 / $1,096.48