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Utah rates for HCPCS L0626

Lumbar Orthosis Sagittal Control With Rigid Posterior Panel(S) Posterior Extends From L-1 To L-5 Vertebra Produces Intracavitary Pressure To Reduce Load On The Intervertebral Discs Includes Straps Closures May Include Padding Stays Shoulder Straps Pendulous Abdomen Design Pre- Fabricated Item That Has Been Trimmed Bent Molded Assembled Or Otherwise Customized To Fit A Specific Patient By An Individual With Expertise(Revised 01/01/14)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$27.03 / $27.03 / $27.03
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.03 / $42.17 / $264.45
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$58.60 / $58.60 / $58.60
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.78 / $58.60 / $62.47
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.21 / $69.44 / $90.27
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.29 / $92.89 / $92.89
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.89 / $66.58 / $99.88
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.78 / $41.86 / $42.60