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New Mexico 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 $81 · 10th–90th $29–$1410%10%20%10th90th$81Professionalmedian $72 · 10th–90th $50–$1580%20%10th90th$72$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. Small sample — interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$77.62 / $77.62 / $77.62
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$50.12 / $70.79 / $147.91
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 / $162.18
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$60.26 / $125.89 / $190.55
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$28.84 / $66.07 / $109.65
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$38.02 / $38.02 / $102.33
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$93.33 / $109.65 / $213.80
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$93.33 / $95.50 / $158.49