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Utah rates for HCPCS L4000

Replace girdle for spinal orthosis (cervical-thoracic-lumbar-sacral orthosis (CTLSO) or spinal orthosis SO)

Facilitymedian $813 · 10th–90th $457–$1,6220%20%40%10th90th$813Professionalmedian $1,096 · 10th–90th $457–$8,3180%10%10th90th$1,096$50.0$100.0$200.0$500.0$1.0K$2.0K$5.0K

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$457.09 / $457.09 / $457.09
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$457.09 / $912.01 / $8,317.64
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$891.25 / $891.25 / $891.25
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$660.69 / $660.69 / $891.25
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$60.26 / $1,202.26 / $1,548.82
Regence BlueShield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,548.82 / $1,621.81 / $1,621.81
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,174.90 / $1,174.90 / $1,819.70
Select Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,621.81 / $1,621.81 / $1,659.59
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,174.90 / $1,659.59 / $1,995.26
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$602.56 / $724.44 / $954.99
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$562.34 / $724.44 / $1,318.26