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Virginia 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 $138 · 10th–90th $69–$2190%50%10th90th$138Professionalmedian $72 · 10th–90th $39–$1700%10%20%10th90th$72$0.2$2.0$20.0$200.0$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
$57.54 / $169.82 / $169.82
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$57.54 / $77.62 / $169.82
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$138.04 / $138.04 / $144.54
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$38.90 / $38.90 / $81.28
CareFirst
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$77.62 / $77.62 / $81.28
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$52.48 / $52.48 / $102.33
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$38.02 / $38.02 / $38.02
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$91.20 / $131.83 / $208.93
Medcost
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$50.12 / $107.15 / $194.98
Medcost
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$128.82 / $128.82 / $169.82
Sentara
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$95.50 / $181.97 / $10,000.00
Sentara
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$95.50 / $181.97 / $10,000.00
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$70.79 / $93.33 / $213.80
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$97.72 / $104.71 / $169.82