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Utah rates for HCPCS L0976

Lumbar-sacral orthosis (LSO), full corset

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$57.54 / $57.54 / $57.54
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.54 / $114.82 / $794.33
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$117.49 / $117.49 / $117.49
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.11 / $85.11 / $123.03
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.26 / $165.96 / $218.78
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$169.82 / $199.53 / $346.74
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $162.18 / $234.42
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$186.21 / $229.09 / $234.42
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$165.96 / $234.42 / $269.15
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$74.13 / $89.13 / $102.33
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.79 / $89.13 / $128.82