go back

Wyoming 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
$49.08 / $49.08 / $111.01
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$85.10 / $85.10 / $85.10
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.10 / $85.10 / $85.10
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$52.17 / $52.17 / $190.12
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.08 / $38.08 / $52.17
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$94.18 / $95.03 / $109.88