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Connecticut 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 $72 · 10th–90th $72–$1350%50%90th$72Professionalmedian $72 · 10th–90th $40–$1450%20%40%10th90th$72$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. Small sample — interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$72.44 / $72.44 / $72.44
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$61.66 / $72.44 / $144.54
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$107.15 / $138.04 / $165.96
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$38.90 / $38.90 / $134.90
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$52.48 / $52.48 / $120.23
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$38.02 / $38.02 / $38.02
ConnectiCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$87.10 / $87.10 / $120.23
ConnectiCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$77.62 / $97.72 / $138.04
Health New England
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$234.42 / $234.42 / $234.42
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$77.62 / $93.33 / $134.90
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$70.79 / $104.71 / $162.18