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Iowa 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 $155 · 10th–90th $93–$4790%10%20%10th90th$155Professionalmedian $79 · 10th–90th $63–$1700%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
$95.50 / $95.50 / $154.88
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$61.66 / $75.86 / $147.91
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$52.48 / $52.48 / $194.98
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$52.48 / $151.36 / $190.55
Hally Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$112.20 / $213.80 / $223.87
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$95.50 / $223.87 / $575.44
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$102.33 / $144.54 / $316.23
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$190.55 / $204.17 / $467.74
Midlands
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$194.98 / $194.98 / $194.98
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$77.62 / $158.49 / $416.87
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$95.50 / $104.71 / $181.97
Wellmark
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$134.90 / $169.82 / $169.82