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New Hampshire 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
$72.00 / $72.00 / $86.40
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.50 / $72.00 / $72.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$133.52 / $133.52 / $158.27
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.00 / $39.00 / $39.00
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
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$168.49 / $168.49 / $520.04
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$69.20 / $103.82 / $168.49