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Louisiana 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
$115.87 / $123.00 / $165.69
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.00 / $115.87 / $133.69
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$186.60 / $318.77 / $448.09
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.66 / $126.84 / $126.84
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.00 / $40.00 / $40.00
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 / $52.17
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.35 / $106.00 / $166.07