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South Dakota 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 $120 · 10th–90th $107–$2400%20%10th90th$120Professionalmedian $120 · 10th–90th $71–$1910%10%20%10th90th$120$50.0$100.0$200.0$500.0$1.0K

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
$107.15 / $107.15 / $107.15
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$69.18 / $107.15 / $120.23
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$52.48 / $52.48 / $194.98
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$151.36 / $151.36 / $190.55
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$120.23 / $131.83 / $323.59
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$89.13 / $144.54 / $891.25
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$190.55 / $190.55 / $194.98
Midlands
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$194.98 / $194.98 / $194.98
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$194.98 / $194.98 / $194.98
Sanford Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$131.83 / $147.91 / $173.78
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$22.91 / $134.90 / $177.83
Wellmark
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$169.82 / $169.82 / $169.82