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Utah rates for HCPCS L0643

Lumbar-Sacral Orthosis Sagittal Control With Rigid Posterior Panel(S) Posterior Extends From Sacrococcygeal Junction To T-9 Vertebra Produces Intracavitary Pressure To Reduce Load On The Intervertebral Discs Includes Straps Closures May Include Padding Stays Shoulder Straps Pendulousabdomen Design Prefabricated Off-The-Shelf

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$75.05 / $75.05 / $75.05
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.80 / $75.05 / $549.51
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$128.79 / $128.79 / $128.79
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$94.02 / $128.79 / $137.30
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.61 / $43.73 / $60.00
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$78.06 / $78.06 / $105.58
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.29 / $69.95 / $112.05
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.41 / $86.98 / $88.70