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Utah rates for HCPCS L0631

Lumbar-Sacral Orthosis Sagittal Control With Rigid Anterior And Posterior Panels Posterior Extends From Sacrococcygeal Junction To T-9 Vertebra Produces Intracavitary Pressure To Reduce Load On The Intervertebral Discs Includesstraps Closures May Include Padding Shoulder Straps Pendulous Abdomen Design Prefabricated Item That Has Been Trimmed Bent Molded Assembleassembled Or Otherwise Customized To Fit A Specific Patient By An (Revised 01/01/14)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$355.96 / $355.96 / $355.96
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$355.96 / $555.32 / $3,483.15
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$756.07 / $756.07 / $756.07
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$551.92 / $756.07 / $806.01
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$567.10 / $914.68 / $1,189.08
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,097.11 / $1,223.58 / $1,223.58
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$696.75 / $877.07 / $1,315.60
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$431.73 / $551.38 / $647.59