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Nebraska 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 $166 · 10th–90th $87–$5750%20%10th90th$166Professionalmedian $98 · 10th–90th $52–$2570%10%20%10th90th$98$50.0$100.0$200.0$500.0$1.0K

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
$97.72 / $97.72 / $97.72
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$48.98 / $97.72 / $257.04
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$114.82 / $125.89 / $125.89
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$52.48 / $52.48 / $194.98
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$38.02 / $190.55 / $363.08
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$97.72 / $169.82 / $575.44
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$70.79 / $104.71 / $173.78
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$190.55 / $190.55 / $467.74
Midlands
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$194.98 / $194.98 / $194.98
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$257.04 / $436.52 / $467.74
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$77.62 / $117.49 / $181.97
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$70.79 / $104.71 / $169.82