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Rhode Island rates for HCPCS L0623

Sacroiliac Orthosis 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 (Revised 01/01/14)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.00 / $72.00 / $72.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$253.50 / $281.67 / $375.51
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$113.49 / $116.68 / $124.73
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
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$78.48 / $125.57 / $173.03