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Vermont 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 $52 · 10th–90th $52–$1170%50%90th$52Professionalmedian $72 · 10th–90th $72–$930%50%90th$72$50.0$100.0$200.0$500.0

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
$72.44 / $72.44 / $93.33
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
MVP Health Care
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$128.82 / $169.82 / $169.82
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$93.33 / $93.33 / $117.49
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$74.13 / $144.54 / $309.03