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Iowa 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
$106.62 / $106.62 / $156.84
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.50 / $80.87 / $147.04
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$52.17 / $52.17 / $190.12
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.17 / $151.88 / $190.12
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$113.35 / $207.87 / $224.60
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$61.45 / $223.82 / $580.79
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$95.03 / $110.87 / $289.88
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$190.12 / $191.04 / $259.23
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$191.04 / $224.69 / $399.85
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$94.18 / $105.85 / $225.39
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$169.38 / $169.38 / $169.38
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$133.81 / $169.38 / $169.38