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Utah rates for HCPCS L0648

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$478.63 / $478.63 / $478.63
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$295.12 / $478.63 / $912.01
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$758.58 / $758.58 / $758.58
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$549.54 / $549.54 / $812.83
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.67 / $275.42 / $371.54
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$549.54 / $645.65 / $1,148.15
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$363.08 / $363.08 / $724.44
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$512.86 / $524.81 / $1,047.13
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$467.74 / $524.81 / $776.25
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$457.09 / $549.54 / $588.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.83 / $524.81 / $691.83