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Utah rates for HCPCS L0642

Lumbar orthosis (LO), sagittal control, with rigid anterior and posterior panels, 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, shoulder straps, pendulous abdomen design, prefabricated, off-the-shelf

Facilitymedian $200 · 10th–90th $191–$2690%20%40%10th90th$200Professionalmedian $245 · 10th–90th $115–$4680%10%10th90th$245$50.0$100.0$200.0$500.0

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
$190.55 / $190.55 / $190.55
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$114.82 / $269.15 / $588.84
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$302.00 / $302.00 / $302.00
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$218.78 / $218.78 / $302.00
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$34.67 / $112.20 / $151.36
Regence BlueShield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$199.53 / $204.17 / $269.15
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$147.91 / $147.91 / $288.40
Select Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$204.17 / $208.93 / $416.87
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$190.55 / $208.93 / $309.03
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$181.97 / $218.78 / $234.42
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$53.70 / $213.80 / $346.74