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Michigan 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 $141 · 10th–90th $59–$4570%20%10th90th$141Professionalmedian $79 · 10th–90th $60–$1410%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
$79.43 / $79.43 / $79.43
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$60.26 / $72.44 / $125.89
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$151.36 / $338.84 / $645.65
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$112.20 / $112.20 / $120.23
CareSource
Facility/Professional
Facility
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 / $52.48
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$38.02 / $52.48 / $177.83
Health Alliance Plan
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$23.44 / $58.88 / $79.43
Health Alliance Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$21.88 / $72.44 / $147.91
Priority Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$52.48 / $52.48 / $52.48
Priority Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$38.02 / $52.48 / $177.83
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$75.86 / $117.49 / $213.80
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$70.79 / $104.71 / $173.78