go back

Hawaii 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 $76 · 10th–90th $52–$1170%20%40%10th90th$76Professionalmedian $87 · 10th–90th $71–$2040%20%10th90th$87$10.0$20.0$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
Professional
Modifier
Typical Low / Median / Typical High
$70.79 / $72.44 / $107.15
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
$52.48 / $186.21 / $251.19
HMSA
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$204.17 / $204.17 / $213.80
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$120.23 / $204.17 / $234.42
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$75.86 / $93.33 / $117.49
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$33.88 / $165.96 / $257.04