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Nationwide rates for HCPCS L0623

Sacroiliac orthosis (SO), provides pelvic-sacral support, with rigid or semi-rigid panels over the sacrum and abdomen, reduces motion about the sacroiliac joint, includes straps, closures, may include pendulous abdomen design, prefabricated, off-the-shelf

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$60.26 / $72.44 / $169.82
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.26 / $72.44 / $144.54
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$29.51 / $39.81 / $165.96
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.90 / $50.12 / $257.04
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$52.48 / $52.48 / $537.03
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.02 / $38.02 / $190.55
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$75.86 / $104.71 / $213.80
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.79 / $107.15 / $165.96