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Kentucky 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
$80.05 / $83.01 / $83.01
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.53 / $73.30 / $91.91
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.12 / $133.52 / $140.33
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.00 / $39.00 / $200.00
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.14 / $180.25 / $220.31
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$113.49 / $160.22 / $220.31
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$52.17 / $52.17 / $155.57
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.08 / $52.17 / $598.16
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.00 / $100.00 / $144.16
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.64 / $106.01 / $150.18