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Indiana 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 $117 · 10th–90th $39–$1450%20%40%10th90th$117Professionalmedian $72 · 10th–90th $40–$1450%20%40%10th90th$72$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
$69.18 / $69.18 / $69.18
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$60.26 / $72.44 / $144.54
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$38.90 / $117.49 / $144.54
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$38.90 / $39.81 / $199.53
CareSource
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$134.90 / $173.78 / $199.53
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$38.02 / $52.48 / $213.80
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$38.02 / $38.02 / $151.36
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$75.86 / $93.33 / $147.91
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$63.10 / $107.15 / $165.96