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Kansas 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
$126.85 / $126.85 / $126.85
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.00 / $83.11 / $126.85
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$84.83 / $92.56 / $98.16
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.87 / $91.87 / $91.87
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 / $52.17 / $189.84
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$28.81 / $119.56 / $580.79
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.35 / $105.85 / $297.23
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.56 / $105.85 / $158.38