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Utah rates for HCPCS L0650

Lumbar-Sacral Orthosis 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