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Utah rates for HCPCS L0641

Lumbar orthosis (LO), sagittal control, with rigid posterior panel(s), posterior extends from L-1 to below L-5 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include padding, stays, shoulder straps, pendulous abdomen design, prefabricated, off-the-shelf

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$36.11 / $36.11 / $36.11
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.19 / $36.11 / $264.45
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$52.17 / $52.17 / $52.17
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.34 / $52.17 / $55.62
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.73 / $21.07 / $60.00
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$37.58 / $37.58 / $50.82
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.09 / $33.67 / $53.93
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.56 / $41.86 / $42.69