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North Dakota 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
$156.84 / $156.84 / $156.84
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$105.57 / $106.62 / $156.84
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$122.40 / $144.72 / $148.32
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$151.88 / $153.38 / $192.88
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47.06 / $130.91 / $580.79
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$88.65 / $110.87 / $235.46
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$53.85 / $107.55 / $235.46