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Alaska 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
Professional
Modifier
Low / Median / High Price
$170.74 / $170.74 / $170.74
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 / $53.74
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$28.81 / $28.81 / $28.81
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$55.88 / $187.58 / $296.18
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$28.81 / $28.81 / $52.17
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.08 / $53.74 / $133.27
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$103.82 / $198.98 / $259.55