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South Carolina 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
Facility
Modifier
Low / Median / High Price
$77.08 / $77.08 / $77.08
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.00 / $77.08 / $144.16
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$173.96 / $173.96 / $216.77
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$52.17 / $52.17 / $57.61
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.08 / $52.17 / $52.17
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$28.81 / $119.26 / $288.10
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$178.27 / $178.27 / $178.27
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.00 / $70.00 / $70.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.31 / $106.01 / $149.12