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Illinois 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 $93 · 10th–90th $71–$4790%20%40%10th90th$93Professionalmedian $76 · 10th–90th $69–$1580%20%40%10th90th$76$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
$70.79 / $70.79 / $117.49
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$69.18 / $72.44 / $117.49
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$213.80 / $288.40 / $1,380.38
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$87.10 / $87.10 / $87.10
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
$38.02 / $38.02 / $154.88
Hally Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$112.20 / $204.17 / $269.15
Hally Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$100.00 / $100.00 / $100.00
Hally Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$147.91 / $147.91 / $147.91
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$87.10 / $93.33 / $257.04
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$77.62 / $107.15 / $173.78