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Missouri 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
$80.20 / $80.20 / $91.86
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.97 / $83.11 / $126.85
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$130.91 / $137.46 / $604.28
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.00 / $39.00 / $141.77
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 / $53.74
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47.06 / $123.99 / $580.79
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$78.48 / $105.85 / $257.89
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$78.48 / $105.85 / $183.65