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Minnesota 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 $195 · 10th–90th $112–$9550%20%10th90th$195Professionalmedian $166 · 10th–90th $72–$1740%50%10th90th$166$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
$107.15 / $107.15 / $107.15
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$61.66 / $72.44 / $125.89
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$154.88 / $173.78 / $467.74
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$138.04 / $173.78 / $173.78
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$302.00 / $489.78 / $1,174.90
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$151.36 / $173.78 / $194.98
Health Partners
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$389.05 / $489.78 / $954.99
Health Partners
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$151.36 / $151.36 / $208.93
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$72.44 / $131.83 / $575.44
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$63.10 / $95.50 / $223.87
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1.58 / $93.33 / $257.04
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$63.10 / $112.20 / $218.78