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Utah rates for HCPCS L0650

Lumbar-sacral orthosis (LSO), sagittal-coronal control, with rigid anterior and posterior frame/panel(s), posterior extends from sacrococcygeal junction to T-9 vertebra, lateral strength provided by rigid lateral frame/panel(s), produces intracavitary pressure to reduce load on 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
$543.83 / $543.83 / $543.83
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$478.94 / $750.00 / $4,104.97
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$812.83 / $812.83 / $952.31
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$593.37 / $812.83 / $952.31
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.00 / $320.76 / $417.49
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$572.62 / $572.62 / $730.08
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$412.86 / $513.13 / $777.08
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$444.95 / $630.26 / $642.71