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Alabama rates for HCPCS L0623

Sacroiliac Orthosis 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 (Revised 01/01/14)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$148.47 / $148.47 / $148.47
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.00 / $148.47 / $148.47
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$134.88 / $134.88 / $134.88
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$52.17 / $52.17 / $113.35
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.08 / $52.17 / $158.16
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.35 / $95.03 / $156.97