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Utah rates for HCPCS L0649

Lumbar-Sacral Orthosis Sagittal-Coronal Control With Rigid Posterior Frame/Panel(S) Posterior Extends From Sacrococcygeal Junction To T-9 Vertebra Lateral Strength Provided By Rigid Lateral Frame/Panels Produces Intracavitary Presssure To Reduce Load On Intervertebral Disc 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
$132.90 / $132.90 / $132.90
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$114.74 / $132.90 / $972.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$211.82 / $211.82 / $211.82
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$154.63 / $211.82 / $218.17
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.06 / $77.44 / $100.78
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$138.24 / $138.24 / $186.96
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$99.67 / $123.88 / $198.42
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.66 / $154.02 / $157.06