go back

New Hampshire 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 $138 · 10th–90th $72–$1620%10%20%10th90th$138Professionalmedian $117 · 10th–90th $39–$1700%20%10th90th$117$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. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$72.44 / $72.44 / $87.10
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$72.44 / $72.44 / $169.82
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$138.04 / $147.91 / $165.96
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 / $213.80
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$63.10 / $77.62 / $109.65
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$69.18 / $117.49 / $138.04
Well Sense
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$128.82 / $128.82 / $128.82