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Rhode Island 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 $275 · 10th–90th $93–$3470%20%10th90th$275Professionalmedian $72 · 10th–90th $71–$1700%50%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
Professional
Modifier
Typical Low / Median / Typical High
$70.79 / $72.44 / $229.09
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$263.03 / $295.12 / $389.05
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$112.20 / $117.49 / $131.83
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
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$93.33 / $125.89 / $213.80
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$95.50 / $138.04 / $169.82