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Mississippi 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
$92.26 / $92.26 / $147.04
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.00 / $106.62 / $147.04
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.70 / $83.70 / $83.70
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$83.70 / $83.70 / $83.70
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
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.35 / $106.96 / $169.36