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Illinois 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
$71.97 / $71.97 / $71.97
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.50 / $72.00 / $109.38
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$228.86 / $674.21 / $1,470.54
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$86.15 / $86.15 / $86.15
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$52.17 / $52.17 / $190.12
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.08 / $52.17 / $151.88
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$113.35 / $203.59 / $268.26
Hally Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$147.36 / $147.36 / $147.36
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$78.48 / $106.38 / $237.57