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Utah rates for HCPCS L0642

Lumbar Orthosis Sagittal Control With Rigid Anterior And Posterior Panels Posterior Extends From L-L To Below L-5 Vertebra Produces Intra- Cavitary Pressure To Reduce Load On The Inter- Vertebral Discs Includes Straps Closures May Include Padding Shoulder Straps Pendulous Abdomen Design Prefabricated Off-The-Shelf

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$190.50 / $190.50 / $190.50
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$164.48 / $267.22 / $1,394.77
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$301.51 / $301.51 / $301.51
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$220.10 / $301.51 / $321.43
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.00 / $111.01 / $144.48
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$198.17 / $198.17 / $268.00
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$142.88 / $177.58 / $284.42
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$155.86 / $220.78 / $225.13