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Utah rates for HCPCS L0631

Lumbar-sacral orthosis (LSO), 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, 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

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