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Washington 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 $79 · 10th–90th $58–$2570%20%10th90th$79Professionalmedian $72 · 10th–90th $49–$1580%10%20%10th90th$72$2.0$10.0$50.0$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. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$69.18 / $69.18 / $165.96
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$50.12 / $72.44 / $154.88
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$57.54 / $57.54 / $169.82
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$51.29 / $53.70 / $147.91
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
Kaiser Permanente
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$57.54 / $131.83 / $407.38
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$57.54 / $128.82 / $223.87
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$51.29 / $58.88 / $64.57
Pacific Source
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$58.88 / $58.88 / $165.96
Premera BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$66.07 / $89.13 / $134.90
Premera BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$48.98 / $48.98 / $89.13
Regence BlueShield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$57.54 / $57.54 / $93.33
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$51.29 / $60.26 / $147.91
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$47.86 / $257.04 / $257.04
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$93.33 / $95.50 / $158.49
Wellpoint
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$36.31 / $51.29 / $147.91