go back

Maine 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 $158 · 10th–90th $52–$1820%20%40%10th90th$158Professionalmedian $72 · 10th–90th $49–$1260%20%10th90th$72$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
$50.12 / $72.44 / $125.89
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$131.83 / $158.49 / $181.97
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$38.90 / $38.90 / $39.81
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 / $52.48
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$117.49 / $117.49 / $141.25
Martin's Point
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$50.12 / $72.44 / $125.89
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$63.10 / $93.33 / $93.33
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$69.18 / $117.49 / $165.96