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Utah rates for HCPCS L0649

Lumbar-sacral orthosis (LSO), 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 pressure to reduce load on intervertebral discs, includes straps, closures, may include padding, stays, shoulder straps, pendulous abdomen design, prefabricated, off-the-shelf

Rates data updated July 2026.

Facilitymedian $132 · 10th–90th $132$1860%50%90th$132Professionalmedian $148 · 10th–90th $56$4170%10%10th90th$148$50.0$100.0$200.0

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$131.83
Median
$131.83
Typical High
$131.83
Aetna
Setting
Professional
Modifier
Global
Typical Low
$56.23
Median
$131.83
Typical High
$416.87
Cigna
Setting
Facility
Modifier
Global
Typical Low
$213.80
Median
$213.80
Typical High
$213.80
Cigna
Setting
Professional
Modifier
Global
Typical Low
$154.88
Median
$154.88
Typical High
$213.80
Molina
Setting
Professional
Modifier
Global
Typical Low
$34.67
Median
$77.62
Typical High
$281.84
Regence BlueShield
Setting
Facility
Modifier
Global
Typical Low
$138.04
Median
$141.25
Typical High
$186.21
Regence BlueShield
Setting
Professional
Modifier
Global
Typical Low
$102.33
Median
$102.33
Typical High
$194.98
Select Health
Setting
Facility
Modifier
Global
Typical Low
$147.91
Median
$147.91
Typical High
$147.91
Select Health
Setting
Professional
Modifier
Global
Typical Low
$72.44
Median
$147.91
Typical High
$281.84
U of Utah Health Plan
Setting
Professional
Modifier
Global
Typical Low
$131.83
Median
$147.91
Typical High
$218.78
United
Setting
Facility
Modifier
Global
Typical Low
$128.82
Median
$154.88
Typical High
$190.55
United
Setting
Professional
Modifier
Global
Typical Low
$37.15
Median
$147.91
Typical High
$218.78