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Arkansas 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 / $72.00 / $72.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.00 / $72.00 / $78.03
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$219,999.78 / $539,999.46 / $949,999.05
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$114.60 / $151.68 / $168.53
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$133.52 / $133.52 / $133.52
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$133.52 / $133.52 / $133.52
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$52.17 / $52.17 / $106.82
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.08 / $52.17 / $103.71
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.35 / $102.95 / $141.34