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Texas 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 $102 · 10th–90th $58$6030%10%20%10th90th$102Professionalmedian $78 · 10th–90th $63$1260%20%40%10th90th$78$0.2$1.0$5.0$20.0$100.0$500.0$2.0K

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
$70.79 / $72.44 / $72.44
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$66.07 / $72.44 / $114.82
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$3,162.28 / $3,388.44 / $4,168.69
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$83.18 / $83.18 / $83.18
Christus
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$79.43 / $128.82 / $128.82
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
Lucent Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$602.56 / $602.56 / $602.56
Lucent Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$891.25 / $891.25 / $891.25
Moda Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$28.84 / $117.49 / $269.15
Moda Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$69.18 / $72.44 / $123.03
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$138.04 / $138.04 / $141.25
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$50.12 / $104.71 / $245.47
Providence
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
$77.62 / $102.33 / $181.97
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$79.43 / $125.89 / $158.49
Wellpoint
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$38.90 / $128.82 / $128.82