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Montana 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 $102 · 10th–90th $85–$2510%20%10th90th$102Professionalmedian $85 · 10th–90th $39–$2090%10%10th90th$85$50.0$100.0$200.0

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
Professional
Modifier
Typical Low / Median / Typical High
$38.90 / $72.44 / $154.88
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$52.48 / $181.97 / $181.97
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$52.48 / $181.97 / $181.97
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$85.11 / $102.33 / $251.19
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$85.11 / $102.33 / $251.19
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$52.48 / $89.13 / $181.97
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$58.88 / $100.00 / $181.97
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$75.86 / $93.33 / $117.49
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$93.33 / $95.50 / $158.49