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Utah rates for HCPCS L0636

Lumbar Sacral Orthosis 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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$514.15 / $514.15 / $514.15
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$514.15 / $725.55 / $6,141.28
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,030.36 / $1,030.36 / $1,030.36
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$752.17 / $752.17 / $1,893.75
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$849.36 / $1,369.94 / $1,780.92
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,643.18 / $1,832.58 / $1,832.58
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,043.53 / $1,313.59 / $1,970.39
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$623.59 / $796.42 / $1,019.74