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Georgia 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 $138 · 10th–90th $79–$5010%10%20%10th90th$138Professionalmedian $83 · 10th–90th $68–$1950%20%10th90th$83$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
$79.43 / $79.43 / $213.80
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$69.18 / $79.43 / $147.91
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$138.04 / $323.59 / $501.19
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$39.81 / $177.83 / $213.80
CareSource
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$134.90 / $134.90 / $134.90
CareSource
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$112.20 / $112.20 / $112.20
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 / $151.36
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $138.04 / $302.00
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$70.79 / $93.33 / $141.25
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$70.79 / $107.15 / $177.83