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Oklahoma 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
$74.84 / $74.84 / $74.84
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.08 / $73.45 / $74.84
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 / $52.17
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$28.81 / $78.59 / $580.79
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.35 / $106.00 / $183.36
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.35 / $102.03 / $156.97