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Colorado 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
$49.08 / $49.08 / $49.08
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.08 / $50.40 / $119.20
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$87.65 / $98.48 / $178.81
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.00 / $39.00 / $82.39
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 / $38.08 / $151.88
Denver HMP
Facility/Professional
Facility
Modifier
Low / Median / High Price
$28.81 / $49.08 / $164.17
Denver HMP
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.81 / $28.81 / $28.81
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.98 / $109.56 / $192.83
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$94.18 / $95.03 / $156.97