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Idaho 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
Professional
Modifier
Low / Median / High Price
$39.77 / $109.38 / $109.38
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
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$28.81 / $58.82 / $109.38
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.94 / $83.27 / $87.65
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $127.32 / $153.72
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$85.10 / $85.10 / $127.65
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.36 / $63.98 / $92.03
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$94.18 / $95.03 / $156.97