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Utah rates for HCPCS L0636

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

Facilitymedian $1,023 · 10th–90th $513–$1,8620%20%40%10th90th$1,023Professionalmedian $1,122 · 10th–90th $513–$9,3330%10%10th90th$1,122$50.0$200.0$1.0K$5.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Small sample — interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$512.86 / $512.86 / $512.86
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$512.86 / $1,047.13 / $9,332.54
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,023.29 / $1,023.29 / $1,023.29
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$758.58 / $758.58 / $1,023.29
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$60.26 / $1,380.38 / $1,737.80
Regence BlueShield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,778.28 / $1,862.09 / $1,862.09
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,148.15 / $1,348.96 / $1,819.70
Select Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,659.59 / $1,862.09 / $1,905.46
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,348.96 / $1,905.46 / $1,995.26
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$660.69 / $794.33 / $1,047.13
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$616.60 / $794.33 / $1,513.56