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North Carolina 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
$144.16 / $144.16 / $144.16
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$69.80 / $144.16 / $144.16
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$210.41 / $244.22 / $300.76
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$121.11 / $130.47 / $139.16
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 / $151.88
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$28.81 / $144.16 / $178.27
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$178.27 / $178.27 / $178.27
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$140.60 / $140.60 / $140.60
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.31 / $106.96 / $159.01
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$207.42 / $580.79 / $580.79
Wellcare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$888.53 / $888.53 / $888.53