go back

Vermont 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
$61.66 / $72.44 / $93.33
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$52.48 / $52.48 / $52.48
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.02 / $38.02 / $52.48
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$114.82 / $134.90 / $169.82
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$93.33 / $93.33 / $117.49
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.44 / $165.96 / $323.59