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Utah rates for HCPCS L0627

Lumbar Orthosis Sagittal Control With Rigid Anterior And Posterior Panels Posterior Extends From L-1 To Below L-5 Vertebra Produces Intra- Cavitary Pressure To Reduce The Load On The Inter-Vertebral Discs Includes Straps Closures May Include Padding Shoulder Straps Pendulous Abdomen Design Prefabricated 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
$142.53 / $142.53 / $142.53
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$142.53 / $265.79 / $1,394.77
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$312.81 / $312.81 / $312.81
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$228.35 / $312.81 / $333.47
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$227.07 / $366.25 / $476.12
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$439.29 / $489.93 / $489.93
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$278.98 / $351.18 / $526.77
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$172.87 / $220.78 / $259.31