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Arizona 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 $107 · 10th–90th $32–$2690%10%10th90th$107Professionalmedian $72 · 10th–90th $50–$1580%20%40%10th90th$72$0.2$1.0$5.0$20.0$100.0$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
$60.26 / $72.44 / $147.91
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$33.11 / $138.04 / $257.04
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$95.50 / $125.89 / $239.88
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 / $52.48
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$28.84 / $72.44 / $575.44
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$72.44 / $95.50 / $891.25
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$75.86 / $102.33 / $109.65
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$63.10 / $95.50 / $158.49