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Pennsylvania 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 $214 · 10th–90th $62–$2400%20%40%10th90th$214Professionalmedian $72 · 10th–90th $58–$1550%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
$61.66 / $239.88 / $239.88
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$57.54 / $72.44 / $147.91
Capital Blue Cross
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$5,011.87 / $8,511.38 / $77,624.71
Capital Blue Cross
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$117.49 / $117.49 / $117.49
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$52.48 / $52.48 / $83.18
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$38.02 / $38.02 / $53.70
Emblem Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$109.65 / $158.49 / $229.09
Geisinger
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$120.23 / $120.23 / $120.23
Geisinger
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$72.44 / $85.11 / $120.23
Highmark BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$467.74 / $467.74 / $467.74
Highmark BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$112.20 / $112.20 / $112.20
Martin's Point
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$61.66 / $61.66 / $61.66
Martin's Point
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$61.66 / $72.44 / $147.91
Oscar Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.60 / $295.12 / $295.12
UPMC Health Plan
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$134.90 / $190.55 / $190.55
UPMC Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$131.83 / $134.90 / $190.55
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$93.33 / $213.80 / $245.47
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$77.62 / $104.71 / $181.97