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Florida 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
$50.40 / $72.00 / $72.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.40 / $72.00 / $144.16
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 / $53.74
Florida Blue
Facility/Professional
Facility
Modifier
Low / Median / High Price
$99,999.99 / $99,999.99 / $99,999.99
Florida Blue
Facility/Professional
Professional
Modifier
Low / Median / High Price
$80.11 / $133.52 / $199.76
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.71 / $36.47 / $40.12
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$86.33 / $106.96 / $156.97
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.47 / $36.47 / $39.00