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Utah 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 $72 · 10th–90th $72–$870%20%40%90th$72Professionalmedian $87 · 10th–90th $38–$2570%10%20%10th90th$87$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
Facility
Modifier
Typical Low / Median / Typical High
$72.44 / $72.44 / $72.44
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$33.88 / $72.44 / $257.04
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
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$30.20 / $47.86 / $61.66
Regence BlueShield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$85.11 / $87.10 / $114.82
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$63.10 / $63.10 / $125.89
Select Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$87.10 / $89.13 / $177.83
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$75.86 / $89.13 / $107.15
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$75.86 / $79.43 / $95.50
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$22.91 / $93.33 / $134.90