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New York 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 $151 · 10th–90th $72–$2510%10%20%10th90th$151Professionalmedian $72 · 10th–90th $40–$1950%10%20%10th90th$72$0.2$2.0$20.0$200.0$2.0K$20.0K

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
$72.44 / $162.18 / $173.78
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$57.54 / $72.44 / $154.88
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$120.23 / $120.23 / $239.88
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$39.81 / $39.81 / $234.42
CDPHP
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$141.25 / $151.36 / $151.36
CDPHP
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$151.36 / $151.36 / $151.36
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$52.48 / $52.48 / $53,703.18
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$38.02 / $38.02 / $173.78
Emblem Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$120.23 / $199.53 / $457.09
Emblem Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$77.62 / $131.83 / $229.09
Excellus BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$213.80 / $213.80 / $223.87
Excellus BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$91.20 / $97.72 / $213.80
MVP Health Care
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$457.09 / $50,118.72 / $75,857.76
MVP Health Care
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$93.33 / $114.82 / $169.82
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$77.62 / $109.65 / $331.13
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$69.18 / $117.49 / $208.93
Univera
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$77.62 / $85.11 / $223.87
Univera
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$77.62 / $97.72 / $213.80