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Alaska 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

Facilitymedian $29 · 10th–90th $29–$1910%50%90th$29Professionalmedian $85 · 10th–90th $62–$1910%10%10th90th$85$50.0$100.0$200.0$500.0

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$61.66 / $79.43 / $144.54
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$52.48 / $52.48 / $52.48
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$38.02 / $38.02 / $218.78
Moda Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$28.84 / $60.26 / $190.55
Moda Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$60.26 / $190.55 / $302.00
Premera BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$89.13 / $190.55 / $204.17
Premera BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$169.82 / $190.55 / $204.17
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$28.84 / $28.84 / $169.82
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$38.02 / $53.70 / $218.78
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$75.86 / $75.86 / $93.33
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$102.33 / $158.49 / $257.04