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California 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 $37 · 10th–90th $30$1700%20%10th90th$37Professionalmedian $79 · 10th–90th $50$2570%20%10th90th$79$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
Facility
Modifier
Typical Low / Median / Typical High
$72.44 / $72.44 / $257.04
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$69.18 / $74.13 / $257.04
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$120.23 / $120.23 / $120.23
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$29.51 / $37.15 / $147.91
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$38.90 / $39.81 / $199.53
Blue Shield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$125.89 / $398.11 / $512.86
Blue Shield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$100.00 / $173.78 / $257.04
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
Contra Costa Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$47.86 / $66.07 / $81.28
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$42.66 / $158.49 / $281.84
Lucent Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$602.56 / $602.56 / $602.56
Lucent Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$891.25 / $891.25 / $891.25
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $125.89
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$28.84 / $61.66 / $138.04
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$38.02 / $38.02 / $79.43
Sutter Health Plus
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$389.05 / $389.05 / $389.05
The Alliance
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$47.86 / $47.86 / $54.95
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$15.85 / $93.33 / $213.80
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$60.26 / $102.33 / $177.83