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Maryland 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
$57.97 / $72.00 / $144.16
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$78.52 / $78.52 / $79.62
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 / $52.17
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$82.01 / $117.15 / $175.73
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$86.33 / $106.32 / $165.49
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.00 / $39.00 / $82.01