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Oregon 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
Professional
Modifier
Low / Median / High Price
$62.04 / $69.80 / $600.41
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
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$41.17 / $123.57 / $161.18
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$44.12 / $62.04 / $98.18
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.94 / $57.10 / $88.38
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$58.82 / $87.65 / $170.81
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$52.17 / $62.04 / $98.18
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.08 / $88.38 / $173.03
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$78.48 / $294.20 / $346.06
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.17 / $64.70 / $178.50
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.10 / $95.03 / $156.97