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Utah rates for HCPCS L0635

Lumbar-sacral orthosis (LSO), sagittal-coronal control, lumbar flexion, rigid posterior frame/panel(s), lateral articulating design to flex the lumbar spine, posterior extends from sacrococcygeal junction to T-9 vertebra, lateral strength provided by rigid lateral frame/panel(s), produces intracavitary pressure to reduce load on intervertebral discs, includes straps, closures, may include padding, anterior panel, pendulous abdomen design, prefabricated, includes fitting and adjustment

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$347.31 / $347.31 / $347.31
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$347.31 / $491.01 / $4,148.45
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$711.81 / $711.81 / $711.81
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$519.62 / $711.81 / $733.16
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$488.08 / $787.24 / $1,023.41
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$944.25 / $1,053.08 / $1,053.08
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$599.66 / $754.86 / $1,132.29
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$413.34 / $533.17 / $647.02