go back

Wisconsin 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 $117 · 10th–90th $110–$2140%20%40%10th90th$117Professionalmedian $107 · 10th–90th $62–$1740%20%10th90th$107$0.2$1.0$5.0$20.0$100.0$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. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$70.79 / $70.79 / $70.79
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$60.26 / $70.79 / $125.89
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$117.49 / $117.49 / $190.55
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$107.15 / $107.15 / $131.83
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$52.48 / $407.38 / $645.65
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$38.02 / $190.55 / $218.78
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$70.79 / $112.20 / $138.04
DeanCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$112.20 / $128.82 / $162.18
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$70.79 / $125.89 / $575.44
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$95.50 / $114.82 / $257.04
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$50.12 / $64.57 / $70.79
Network Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$107.15 / $151.36 / $281.84
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$93.33 / $134.90 / $223.87
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$52.48 / $229.09 / $575.44
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$38.02 / $75.86 / $891.25
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$70.79 / $109.65 / $177.83
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$70.79 / $107.15 / $173.78