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Utah rates for HCPCS L0638

Lumbar-Sacral Orthosis 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