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Massachusetts 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 $72 · 10th–90th $72–$6030%50%90th$72Professionalmedian $107 · 10th–90th $62–$1580%20%10th90th$107$0.2$2.0$20.0$200.0$2.0K$20.0K

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
$72.44 / $72.44 / $72.44
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$60.26 / $72.44 / $147.91
AllWays Health Partners
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$128.82 / $147.91 / $602.56
AllWays Health Partners
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$77.62 / $128.82 / $181.97
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 / $144.54
Fallon Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$60.26 / $3,630.78 / $9,772.37
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$117.49 / $117.49 / $177.83
Health New England
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$234.42 / $234.42 / $234.42
Mass General Brigham
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$128.82 / $147.91 / $602.56
Mass General Brigham
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$77.62 / $128.82 / $181.97
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$63.10 / $117.49 / $213.80
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$77.62 / $117.49 / $165.96