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Utah rates for HCPCS L0638

Lumbar-sacral orthosis (LSO), sagittal-coronal control, with rigid anterior and posterior frame/panels, 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, shoulder straps, pendulous abdomen design, custom fabricated

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$457.21 / $457.21 / $457.21
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$457.21 / $529.66 / $4,475.02
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,115.23 / $1,115.23 / $1,115.23
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$814.12 / $1,115.23 / $1,188.90
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$727.15 / $1,172.83 / $1,524.67
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,406.76 / $1,568.91 / $1,568.91
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$893.39 / $1,124.58 / $1,686.89
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$554.53 / $708.22 / $906.81