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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
$72.00 / $74.84 / $86.40
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$69.80 / $72.00 / $119.20
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$113.35 / $133.52 / $186.71
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.00 / $39.00 / $140.59
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$52.17 / $52.17 / $52.17
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.08 / $52.17 / $103.71
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.31 / $105.43 / $165.49